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.