Figure 1.

Spectral-domain optical coherence tomography images of the microstructural reconstruction process of a large macular hole in a 66-year-old female patient. (a) The preoperative minimum and base diameter of the macular hole was 905 μm and 1213 μm, respectively. Note the cystoid edema of the elevated margin and the disrupted external limiting membrane/ellipsoid zone (between the two arrows). The initial best corrected visual acuity was 0.08 (20/250). (b) Closure of the macular hole was observed 2 weeks after surgery, although the tissue filling the macular hole appeared to be sheets of inverted internal limiting membrane (flap closure, arrowheads). The best corrected visual acuity improved to 0.10 (20/200). (c) One month after surgery, the inner layers of the neurosensory retina thickened along the internal limiting membrane scaffold, leaving only a small defect of the outer retina (asterisk). The leading edge of the reconstructing external limiting membrane (arrowheads) and the ellipsoid zone (arrows) were both growing towards the center of the macular hole compared with the original sites before surgery. The best corrected visual acuity at this time was 0.16 (20/125). (d) Three months after surgery, the macular contour appeared further normalized, and the neurosensory retinal tissue above the fovea further thickened, leaving only a cleft (asterisk). Although not fully recovered at this stage, the external limiting membrane and the ellipsoid zone appeared more regular and clear. The best corrected visual acuity was 0.32 (20/63).