Photoreceptor evaluation after successful macular hole closure: an adaptive optics study

Objective: To study photoreceptor changes after a successful macular hole surgery using adaptive optics. Materials and Methods: Three patients who underwent a successful macular hole surgery were studied. Cone density, spacing, and number of nearest neighbors were analyzed at 2 degrees and 4 degrees of eccentricity in all four quadrants using adaptive optics. Results: All three patients gained a visual acuity better than logMAR 0.477 (Snellen equivalent 6/18) at 6 months following successful macular hole surgery. Following successful closure of the macular hole, photoreceptors were appreciated at 2 degrees and 4 degrees of eccentricity from the center. However, as compared with the fellow normal eye, cell density was reduced significantly in the inferior (12,929.33 +/- 2047.50 versus 23,839.67 +/- 3711.16 cells/mm(2) at 2 degrees) and temporal quadrant (13,890 +/- 3424.26 versus 22,578.67 +/- 5651.34 cells/mm(2) at 2 degrees), and intercell spacing was increased significantly in inferior (9.6 +/- 0.92 versus 7.14 +/- 0.545 mu m) and nasal quadrant (8.83 +/- 0.39 versus 7.49 +/- 0.42 mu m). Number of nearest neighbors was unaffected after the hole closure. Conclusion: Postoperative recovery of vision after successful closure of the hole occurs because of the migration or shifting of cells from parafoveal retina toward the center. Cells nearest to the hole margin (at 2 degrees eccentricity) appear to shift more as compared with cells which are further away.