En Face Optical Coherence Tomography of Inner Retinal Defects after Internal Limiting Membrane Peeling for Idiopathic Macular Hole

PURPOSE: To describe the appearance of inner retinal defects using en face spectral domain optical coherence tomography (SD-OCT) after idiopathic full-thickness macular hole (FTMH) surgery, referred to as concentric macular dark spots (CMDS). METHODS: In a retrospective cohort study, the authors evaluated 36 eyes of 36 patients with large idiopathic MH (>400 μm) who underwent standard three-port pars plana vitrectomy with internal limiting membrane (ILM) peeling. All patients were analyzed using B-scan and C-scan en face SD-OCT before and after surgery to determinate the OCT pattern of the retinal surface. RESULTS: Mean follow-up was 10 months (±8.45 SD; range, 3-30 months). Three months after surgery 36 of 36 eyes (100%) showed a CMDS appearance on en face SD-OCT images. Anatomic success rate was 100% (36/36 eyes) after a single surgical procedure. Once they were evident, these dark spots observed on the retinal surface were not progressive and remained stable over time. CONCLUSIONS: Inner retinal defects frequently occurred after idiopathic MH surgery when ILM was peeled. To the authors' knowledge, this feature has not been previously reported using an en face SD-OCT imaging, and it consisted of numerous CMDS in the same direction of the optic nerve fibers. All patients in the study showed this typical OCT pattern 3 months after surgery. Thus, the authors suggest that this is a helpful, noninvasive technique to assess complete ILM removal in FTMH surgery if CMDS appearance on the retinal surface is reported.