Disruption of the photoreceptor inner segment-outer segment junction in eyes with macular holes

Purpose: To examine the relationship between visual acuity and morphologic characteristics of macular holes as determined using spectral domain optical coherence tomography (SID OCT). Methods: A retrospective analysis was performed of eyes with open and closed macular holes at a single, referral-based retina practice. The main outcome measures included best-corrected Snellen visual acuity and SD OCT findings, including the size of the macular hole and the disruption of the junction between inner segments (ISs) and outer segments (OSs) of the photoreceptors. Results: The mean visual acuity for eyes with open (n = 24) and closed (n = 17) macular holes was 20/166 (range, 5/400 to 20/40) and 20/39 (range, 20/80 to 20/25), respectively. The mean macular hole diameter was 859 mu m. A disruption of the IS-OS junction was observed in all eyes, and this disruption had a mean diameter of 1,947 mu m in eyes with an open macular hole and 626 mu m in those with a closed macular hole. There was a negative correlation between both the size of the macular hole (P < 0.001) and the IS-OS disruption (P = 0.01) and visual acuity in eyes with open macular holes. In eyes with closed macular hole, the size of the IS-OS disruption was not correlated with visual acuity (P = 0.82). Conclusions: The photoreceptor layer appears to be involved for a much larger area than that occupied by the macular hole itself. The abnormality in the IS-OS boundary line may reflect perturbation of a higher level of retinal organization and not an absolute loss of photoreceptor OSs.