Retinal Displacement after Idiopathic Macular Hole Surgery: Layer by Layer Analysis

Purpose:To measure the displacement of retinal vascular plexi and choriocapillaris after pars plana vitrectomy for idiopathic macular hole, using optical coherence tomography angiography, and correlate it with clinical data.Methods:Retrospective series with a 6-month follow-up. Records included Best Corrected Visual Acuity, M-charts, structural optical coherence tomography, and optical coherence tomography angiography. Coronal displacement was calculated comparing consecutive images across the 6.4 mm × 6.4 mm field and concentric circular regions of 0.5, 1.5, and 3.0 mm radii. Each circular region was further divided in four quadrants indicated as follows: SuperoTemporal; SuperNasal; InferoTemporal; InferoNasal.Results:The study comprised 33 patients (11 men and 22 women) with 68.9 ± 10.2 years mean age, similar among sexes. Macular hole closed in 31/33 (93.9%) of cases and Best Corrected Visual Acuity improved from mean 20/62 (0.50 ± 0.62 logarithm of Minimum Angle of Resolution) to 20/47 (0.23 ± 0.63 logarithm of Minimum Angle of Resolution; P = 0.0064). Vertical and horizontal metamorphopsia decreased from 0.98 ± 0.68 to 0.51 ± 0.59° (P = 0.0028) and 0.84 ± 0.63 to 0.29 ± 0.45° (P < 0.001), respectively. The average retinal displacement was 81.2 ± 44.1 µm for the superficial plexus and 79.4 ± 45.7 µm for the deep one, both greater than the choriocapillaris displacement (60.9 ± 20.2 µm; P < 0.05). The temporal and superior quadrants displaced more than the others (P < 0.05). Macular hole size correlated to retinal displacement within the central 0.5-mm radius area at all layers (P < 0.05 in all cases).Conclusion:Macular hole closure is associated with significant retinal displacement of all retinal layers and choriocapillaris remodeling. Surgical peeling removes the constraining effect of the internal limiting membrane and promotes a multilayered displacement that fills the retinal defect, likely due to a change in the equilibrium of forces between the contractile retinal structures: the larger superficial retinal vessels and the retinal nerve fiber layer.