Evolution and visual outcomes of outer foveolar lucency after surgery for large idiopathic macular hole.

Purpose: To explore the evolution of outer foveolar lucency (OFL) after vitrectomy and the correlation between OFL and visual acuity (VA) outcome in eyes with large idiopathic macular hole (IMH).

Methods: In this retrospective study, 244 eyes of 233 subjects with large IMH (diameter > 400 μm), who underwent vitrectomy, were included. Preoperative clinical data, postoperative optical coherence tomography (OCT) images, and VA at 1-, 4-, and 10-month visits were documented. The prevalence, incidence, and width of OFL and their correlation with postoperative VA were analyzed.

Results: The prevalence of OFL was 10.4% (24/231) at 1 month and significantly increased to 30.4% (55/181) at 4 months (P < 0.001) and 34.2% (25/73) at 10 months (P < 0.001). The incidence was 26.1% (40/153) and 22.0% (9/41) at 4 and 10 months, respectively. OFL appeared at 1 month while disappeared at 4 or 10 months in 8 eyes (50.0%). The presence of OFL at 1 month was negatively associated with IMH diameter (Nagelkerke R = 0.06; P = 0.02). Eyes with OFL at 4 months had better VA at their 4-month visit than eyes without OFL (P = 0.02). Eyes with early-developed OFLs had better VA at 10 months than those with later-developed ones (P = 0.02). Width of OFL was not associated with postoperative VA at any point.

Conclusions: OFL is not rare in eyes with large IMH after surgery. It can occur gradually and remain during the 10-month follow-up. The presence of OFL appears to have no negative impact on the postoperative VA and it may represent the remodeling of foveal photoreceptors.