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Kim, Kiyoung, MD*; Kim, Eung, Suk, MD, PhD; Kim, Yonguk, MD; Yu, Seung-Young, MD, PhD; Kwak, Hyung, Woo, MD, PhD

doi: 10.1097/IAE.0000000000001679
Original Study

Purpose: To investigate the correlation between preoperative en face spectral domain optical coherence tomography findings of the photoreceptor layer with restoration of foveal microstructure and visual acuity in repaired macular holes.

Methods: Medical records of 106 patients with surgically closed macular holes were retrospectively reviewed. Preoperative OCT slabs of the external limiting membrane (ELM) and ellipsoid zone (EZ) were generated using embedded tools. All patients were classified into two groups according to the presence of preoperative retinal pigment epithelium protrusion seen as hyperreflective spots in EZ slab. Visual acuity, homogenous reflectivity, and glial proliferation in the ELM and EZ slabs were followed for 12 months.

Results: Baseline hyperreflective spots in the EZ slab was observed in 51 (48.1%) eyes. Postoperative homogenous reflectivity and glial proliferation were related to the presence of baseline hyperreflective spots. Vision improvement was significantly greater in the absence of hyperreflective spots group from 9 months after the operation. In logistic regression analysis, the area of hyperreflective spots was significantly associated with foveal homogenous reflectivity at 12 months (P = 0.004).

Conclusion: Preoperative hyperreflective spots in en face EZ slab might be indicative of functional and anatomical restoration after macular hole surgery.

This study aimed to evaluate macular hole with spectral domain optical coherence tomography en face imaging for presence or absence of hyperreflective spots in the ellipsoid zone. The presence of hyperreflective spots significantly correlated with visual acuity, homogeneous reflectivity, and glial proliferation up to 1 year after macular hole surgery.

*Department of Medicine, Kyung Hee University, Seoul, Korea; and

Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Korea.

K. Kim and E. S. Kim equally contributed to this article. Reprint requests: Seung-Young Yu, MD, PhD, Department of Ophthalmology, KyungHee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea 02447; e-mail:

None of the authors have any financial/conflict interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.