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Original article

Microperimetry as a Sensitive Tool for Assessing Functional Outcomes after Idiopathic Macular Hole Surgery

Julius Lukeš ORCID
Jan Ernest ORCID – Kateřina Myslík Manethová ORCID

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DOI: 10.31348/2026/38

Published on website: 23.10.2026

Keywords: idiopathic macular hole, microperimetry, MAIA, ILM peeling, pars plana vitrectomy, best-corrected visual acuity

Summary

References

  1. McCannel CA, Ensminger JL, Diehl NN, et al. Population-based Incidence of Macular Holes. Ophthalmology. 2009;116:1366-1369. doi:10.1016/j.ophtha.2009.01.052
  2. Johnson RN, Gass JDM. Idiopathic Macular Holes. Ophthalmology. 1988;95:917-924. doi:10.1016/S0161-6420(88)33075-7
  3. Chen Q, Liu Z xia. Idiopathic Macular Hole: A Comprehensive Review of Its Pathogenesis and of Advanced Studies on Metamorphopsia. J Ophthal. 2019;2019:1-8. doi:10.1155/2019/7294952
  4. Hirneiss C, Neubauer AS, Gass CA, et al. Visual quality of life after macular hole surgery: outcome and predictive factors. Br J Ophthal. 2007;91:481-484. doi:10.1136/bjo.2006.102376
  5. Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole. Ophthalmology. 2013;120:2611-2619. doi:10.1016/j.ophtha.2013.07.042
  6. Kim SJ, Lim JI, Bailey ST, et al. Idiopathic Macular Hole Preferred Practice Pattern®. Ophthalmology. 2025;132:234-269. doi:10.1016/j.ophtha.2024.12.021
  7. Rambousek J, Veith M, Penčák M, et al. The Success Rate of Persistent Primary Macular Hole Reoperations. Cesk Slov Oftalmol. 2025;81:1-7. doi:10.31348/2025/45
  8. Veith M, Straňák Z, Penčák M, Studený P. Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade. Cesk Slov Oftalmol. 2015;71:170-174.
  9. Tsuboi K, Fukushima M, Akai R. How optical coherence tomography has changed the management of macular holes: A narrative review. Taiwan J Ophthal. 2025;15:344-353. doi: 10.4103/tjo.TJO-D-25-00056
  10. Wilczyński T, Heinke A, Niedzielska-Krycia A, et al. Optical coherence tomography angiography features in patients with idiopathic full-thickness macular hole, before and after surgical treatment. CIA. 2019;Volume 14:505-514. doi:10.2147/CIA. S189417
  11. Teng Y, Yu M, Wang Y, et al. OCT angiography quantifying choriocapillary circulation in idiopathic macular hole before and after surgery. Graefes Arch Clin Exp Ophthal. 2017;255:893-902. doi:10.1007/s00417-017-3586-0
  12. Bacherini D, Savastano MC, Dragotto F, et al. Morpho-Functional Evaluation of Full-Thickness Macular Holes by the Integration of Optical Coherence Tomography Angiography and Microperimetry. JCM. 2020;9:229. doi:10.3390/jcm9010229
  13. Hwang S, Kang MH, Seong M, et al. Swept-Source OCT Angiography Features in Patients after Macular Hole Surgery. JPM. 2022;12:1493. doi:10.3390/jpm12091493
  14. Shahlaee A, Rahimy E, Hsu J, et al. Preoperative and postoperative features of macular holes on en face imaging and optical coherence tomography angiography. Am J Ophthal Case Reports. 2017;5:20-25. doi:10.1016/j.ajoc.2016.10.008
  15. Ooka E, Mitamura Y, Baba T, et al. Foveal Microstructure on Spectral- -Domain Optical Coherence Tomographic Images and Visual Function After Macular Hole Surgery. American Journal of Ophthalmology. 2011;152:283-290.e1. doi:10.1016/j.ajo.2011.02.001
  16. Cappello E, Virgili G, Tollot L, et al. Reading ability and retinal sensitivity after surgery for macular hole and macular pucker. Retina. 2009;29:1111-1118. doi:10.1097/IAE.0b013e3181a3b832
  17. Tranos PG, Ghazi-Nouri SMS, Rubin GS, et al. Visual function and subjective perception of visual ability after macular hole surgery. Am J Ophthal. 2004;138:995-1002. doi:10.1016/j.ajo.2004.07.049
  18. Villate N, Lee JE, Venkatraman A, et al. Photoreceptor layer features in eyes with closed macular holes: Optical coherence tomography findings and correlation with visual outcomes. Am J Ophthal. 2005;139:280-289. doi:10.1016/j.ajo.2004.09.029
  19. Laishram M. Microperimetry – A New Tool for Assessing Retinal Sensitivity in Macular Diseases. JCDR. 2017. doi: 10.7860/JCDR/2017/25799.10213
  20. Horie S, Giulia C, Esmaeilkhanian H, et al. Microperimetry in Retinal Diseases. Asia-Pacific J Ophthal. 2023;12:211-227. doi: 10.1097/APO.0000000000000597
  21. Pfau M, Jolly JK, Wu Z, et al. Fundus-controlled perimetry (microperimetry): Application as outcome measure in clinical trials. Progress Reti Eye Res. 2021;82:100907. doi:10.1016/j.preteyeres.2020.100907
  22. Morales MU, Saker S, Wilde C, et al. Reference Clinical Database for Fixation Stability Metrics in Normal Subjects Measured with the MAIA Microperimeter. Trans Vis Sci Tech. 2016;5:6. doi: 10.1167/tvst.5.6.6
  23. Longhin E, Convento E, Pilotto E, et al. Static and dynamic retinal fixation stability in microperimetry. Canadian Journal of Ophthalmology. 2013;48:375-380. doi:10.1016/j.jcjo.2013.05.021
  24. Dikkaya F, Karaman Erdur S. Retinal Sensitivity and Fixation Analysis Using Microperimetry in Children With Anisometropic Amblyopia. J Pediatr Ophthal Strab. 2020;57:246-250. doi: 10.3928/01913913-20200428-01
  25. Chen W chih, Wang Y, Li X xin. Morphologic and functional evaluation before and after successful macular hole surgery using spectral-domain optical coherence tomography combined with microperimetry. Retina. 2012;32:1733-1742. doi: 10.1097/IA-E.0b013e318242b81a
  26. Huang P, Wang H, Chen F, et al. Functional evaluation with microperimetry in large idiopathic macular holes treated by a free internal limiting membrane flap tamponade technique. BMC Ophthal. 2020;20:302. doi:10.1186/s12886-020-01573-z
  27. Wons J, Pfister IB, Anastasi S, et al. Functional Outcome After Macular Hole Surgery: Comparison of Standard Perimetry with Microperimetry. OPTH. 2022;Volume 16:2235-2243. doi:10.2147/OPTH.S367431
  28. Jun SY, Kong M. Microperimetric analysis of eyes after macular hole surgery with indocyanine green staining: a retrospective study. BMC Ophthal. 2023;23:430. doi:10.1186/s12886-023-03161-3
  29. Sborgia G, Niro A, Sborgia A, et al. Inverted internal limiting membrane-flap technique for large macular hole: a microperimetric study. Int J Retin Vitr. 2019;5:44. doi:10.1186/s40942-019-0195-6
  30. Yanagita T, Shimizu K, Fujimura F, et al. Fixation Point After Successful Macular Hole Surgery With Internal Limiting Membrane Peeling. Ophthalmic Surg Lasers Imag Ret. 2009;40:109-114. doi:10.3928/15428877-20090301-23
  31. Ventre L, Fallico M, Longo A, et al. Conventional internal limiting membrane peeling versus inverted flap for small-to-medium idiopathic macular hole: A Randomized Trial. Retina. 2022;42:2251- 2257. doi:10.1097/IAE.0000000000003622
  32. Tsai MJ, Yang CM, Yang CH, et al. A delphi consensus study for treatment of full-thickness macular hole in Taiwan. Sci Rep. 2025;15:20434. doi:10.1038/s41598-025-06929-3
  33. Kannan NB, Kohli P, Parida H, et al. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial. BMC Ophthalmol. 2018;18:177. doi:10.1186/s12886-018-0826-y
  34. Ďurana V, Hrevuš M, Havrda J, et al. Comparison of Techniques: Inverted Flap and Conventional Internal Limiting Membrane Removal in Idiopathic Macular Hole Surgery. Cesk Slov Oftalmol. 2024;80:240-245. doi:10.31348/2024/31
  35. Vujosevic S, Midena E, Pilotto E, et al. Diabetic Macular Edema: Correlation between Microperimetry and Optical Coherence Tomography Findings. Invest Ophthal Vis Sci. 2006;47:3044. doi: 10.1167/iovs.05-1141
  36. Okada K, Yamamoto S, Mizunoya S, et al. Correlation of retinal sensitivity measured with fundus-related microperimetry to visual acuity and retinal thickness in eyes with diabetic macular edema. Eye. 2006;20:805-809. doi:10.1038/sj.eye.6702014
  37. Levine ES, Moult EM, Greig EC, et al. Multiscale correlation of microvascular changes on optical coherence tomography angiography with retinal sensitivity in diabetic retinopathy. Retina. 2022;42:357-368. doi: 10.1097/IAE.0000000000003299
  38. Springer C, Völcker HE, Rohrschneider K. Chorioretinopathia centralis serosa – Netzhautfunktion und -morphologie: Mikroperimetrie und optische Kohärenztomografie im Vergleich. Ophthalmologe. 2006;103:791-797. doi:10.1007/s00347-006-1396-6
  39. Li H, Chen L, Wu M, et al. Analysis of retinal sensitivity between acute and recurrent central serous chorioretinopathy by microperimetry. Photodiagnosis and Photodynamic Therapy. 2023;42:103576. doi:10.1016/j.pdpdt.2023.103576
  40. Midena E, Pilotto E. Microperimetry in age: related macular degeneration. Eye. 2017;31:985-994. doi:10.1038/eye.2017.34
  41. Roh M, Laíns I, Shin HJ, et al. Microperimetry in age-related macular degeneration: association with macular morphology assessed by optical coherence tomography. Br J Ophthal. 2019;bjophthalmol-2018-313316. doi:10.1136/bjophthalmol-2018-313316
  42. Richter-Mueksch S, Vécsei-Marlovits PV, Sacu SG, et al. Functional Macular Mapping in Patients with Vitreomacular Pathologic Features Before and After Surgery. Am J Ophthal. 2007;144:23-31.e1. doi:10.1016/j.ajo.2007.03.045
  43. Amari F. Predicting visual outcome after macular hole surgery using scanning laser ophthalmoscope microperimetry. Br J Ophthal. 2001;85:96-98. doi:10.1136/bjo.85.1.96
  44. Liu Y, Yang X, Zhou W, et al. Assessment of photoreceptor recovery and visual function utilizing adaptive optics and microperimetry in patients with surgically closed macular holes. Photodiagnosis and Photodynamic Therapy. 2025;51:104458. doi:10.1016/j.pdpdt.2024.104458
  45. Garcin T, Gaudric A, Sikorav A, et al. Internal Limiting Membrane Peeling for Large Macular Holes Induces Only Structural Remodeling without Functional Impairment Over 12 Years. Ophthal Retina. 2025;9:253-262. doi:10.1016/j.oret.2024.09.005
  46. Nakamura T, Murata T, Hisatomi T, et al. Ultrastructure of the vitreoretinal interface following the removal of the internal limiting membrane using indocyanine green. Curr Eye Res. 2003;27:395-9. doi: 10.1076/ceyr.27.6.395.18189
  47. Ito Y, Terasaki H, Takahashi A, et al. Dissociated Optic Nerve Fiber Layer Appearance after Internal Limiting Membrane Peeling for Idiopathic Macular Holes. Ophthalmology. 2005;112:1415-1420. doi:10.1016/j.ophtha.2005.02.023
  48. Clark A, Balducci N, Pichi F, et al. Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling. Retina. 2012;32:1608-1613. doi:10.1097/IAE.0b013e3182437e86
  49. Babu N, Kohli P. Commentary: Retinal changes after internal limiting membrane peeling. Indian Journal of Ophthalmology. 2023;71:933-934. doi:10.4103/ijo.IJO_2272_22
  50. Imai H, Ohta K. Microperimetric determination of retinal sensitivity in areas of dissociated optic nerve fiber layer following internal limiting membrane peeling. Jpn J Ophthal. 2010;54:435-440. doi:10.1007/s10384-010-0839-4
  51. Tadayoni R, Svorenova I, Erginay A, et al. Decreased retinal sensitivity after internal limiting membrane peeling for macular hole surgery. Br J Ophthalmol. 2012;96:1513-1516. doi:10.1136/bjophthalmol-2012-302035
  52. Qi Y, Wang Z, Li SM, et al. Effect of internal limiting membrane peeling on normal retinal function evaluated by microperimetry-3. BMC Ophthalmol. 2020;20:140. doi:10.1186/s12886-020-01383-3
  53. Tortuyaux F, Angioï K, Conart JB, et al. Effets à long terme du pelage de la membrane limitante interne sur la sensibilité et l’anatomie rétinienne lors de la chirurgie des trous maculaires. J Français d’Ophtal. 2021;44:523-530. doi:10.1016/j.jfo.2020.06.049. French.
  54. Itoh Y, Inoue M, Rii T, et al. Significant Correlation Between Visual Acuity and Recovery of Foveal Cone Microstructures After Macular Hole Surgery. Am J Ophthal. 2012;153:111-119.e1. doi: 10.1016/j.ajo.2011.05.039
  55. Oh J, Smiddy WE, Flynn HW, et al. Photoreceptor Inner/Outer Segment Defect Imaging by Spectral Domain OCT and Visual Prognosis after Macular Hole Surgery. Invest Ophthal Vis Sci. 2010;51:1651. doi:10.1167/iovs.09-4420
  56. Sano M, Shimoda Y, Hashimoto H, et al. Restored Photoreceptor Outer Segment and Visual Recovery After Macular Hole Closure. Am J Ophthal. 2009;147:313-318.e1. doi:10.1016/j.ajo.2008.08.002
  57. Wakabayashi T, Fujiwara M, Sakaguchi H, et al. Foveal Microstructure and Visual Acuity in Surgically Closed Macular Holes: Spectral- -Domain Optical Coherence Tomographic Analysis. Ophthalmology. 2010;117:1815-1824. doi:10.1016/j.ophtha.2010.01.017
  58. Bajdik B, Vajas A, Kemenes G, et al. Prediction of long-term visual outcome of idiopathic full-thickness macular hole surgery using optical coherence tomography parameters that estimate potential preoperative photoreceptor damage. Graefes Arch Clin Exp Ophthal. 2024;262:3181-3189. doi:10.1007/s00417-024-06500-2
  59. Tarita-Nistor L, González EG, Markowitz SN, et al. Fixation characteristics of patients with macular degeneration recorded with the mp-1 microperimeter. Retina. 2008;28:125-133. doi: 10.1097/IA-E.0b013e3180ed4571
  60. Shimozono M, Oishi A, Hata M, et al. Restoration of the photoreceptor outer segment and visual outcomes after macular hole closure: spectral-domain optical coherence tomography analysis. Graefes Arch Clin Exp Ophthal. 2011;249:1469-1476. doi: 10.1007/s00417-011-1681-1
  61. Lee MW, Kim TY, Song YY, et al. Changes in each retinal layer and ellipsoid zone recovery after full-thickness macular hole surgery. Sci Rep. 2021;11:11351. doi:10.1038/s41598-021-90955-4
  62. Sevgi DD, Yee PS, Srivastava SK, et al. Longitudinal ellipsoid zone dynamics after macular hole repair in the discover study: Structure–Function Assessment. Retina. 2021;41:915-920. doi: 10.1097/IAE.0000000000002983
  63. Elhusseiny AM, Schwartz SG, Flynn HW, et al. Long-Term Outcomes after Macular Hole Surgery. Ophthal Retina. 2020;4:369-376. doi:10.1016/j.oret.2019.09.015
  64. Kaźmierczak K, Stafiej J, Stachura J, et al. Long-Term Anatomic and Functional Outcomes after Macular Hole Surgery. J Ophthal. 2018;2018:1-9. doi:10.1155/2018/3082194
  65. Passemard M, Yakoubi Y, Muselier A, et al. Long-term Outcome of Idiopathic Macular Hole Surgery. Am J Ophthal. 2010;149:120-126. doi:10.1016/j.ajo.2009.08.003
  66. Fischer C, Bruggemann A, Hager A, et al. Vascular Occlusions following Ocular Surgical Procedures: A Clinical Observation of Vascular Complications after Ocular Surgery. J Ophthal. 2017;2017:1-6. doi:10.1155/2017/9120892
  67. Russell JF, Scott NL, Haddock LJ, et al. Central retinal artery occlusion on postoperative day one after vitreoretinal surgery. Am J Ophthalmol Case Rep. 2018;12:93-96. doi: 10.1016/j.ajoc.2018.10.001