Correlation of Preoperative Retinal Pigment Epithelium Status with Foveal Microstructure in Repaired Macular Holes

Purpose:To evaluate the preoperative status of the retinal pigment epithelium (RPE) and identify a correlation with reconstructive changes in foveal microstructures and visual outcomes in eyes with surgically closed macular holes (MHs). Methods:Retrospective, consecutive, observational case series. Spectral-domain optical coherence tomography (SD-OCT) was performed to assess the preoperative morphology of the RPE and foveal microstructural changes 12 months postoperatively. The correlation between the preoperative RPE status with the postoperative integrity of the foveal photoreceptor layer and the best corrected visual acuity (BCVA) was evaluated. Results:Fifty-two eyes (52 patients) with surgically closed MHs were included. According to the pre-operative status of the RPE line, the eyes were categorized into 3 groups: 27 eyes (52%) showed none RPE line alteration (Group A), 16 eyes (31%) showed a small RPE line alteration (Group B), and 9 eyes (17%) showed a diffuse RPE line alteration (Group C). At SD-OCT examination at 12 months, 27 eyes (52%) showed complete integrity of the inner segment and outer segment junction (IS/OS) line and external limiting membrane (ELM) line, 21 eyes (40%) had alterations of the IS/OS line with an intact ELM line and 4 eyes (8%) had alterations of the IS/OS line and ELM line. Forward stepwise regression analysis showed that factors significantly correlated with postoperative degree of integrity of the photoreceptor layer were: preoperative status of the RPE line (P = 0.001), and base diameter of the hole (P = 0.029). At 12 months the mean BCVA was significantly different among the 3 groups. The values for groups A and B were significantly higher than for group C (P < 0.05, Tukey-Kramer test), while there was no significant difference between groups A and B (P = not significant). Conclusions:Preoperative RPE layer integrity evaluated by SD-OCT may be indicative of good photoreceptor restoration and visual recovery in patients with surgically closed MHs.