Intraretinal Fluid Area May Not Predict Vision Following Macular Hole Repair

Intraretinal fluid area does not demonstrate strong correlations with best-corrected visual acuity following macular hole repair.

Preoperative intraretinal fluid area is likely only negligibly correlated with best-corrected visual acuity (BCVA) following surgery to repair idiopathic macular holes, according to research published in the Canadian Journal of Ophthalmology. This negligible correlation disqualifies this metric from predicting postsurgical vision, the report suggests.

Researchers included 251 participants (mean age, 68.71 years; 68.1% women) in a retrospective cohort study to investigate potential associations between preoperative intraretinal fluid area and pre and postoperative BCVA in surgically repaired, idiopathic macular holes. Study participants underwent spectral domain-optical coherence tomography (SD-OCT), pre and postoperative central subfield thickness measurements, and macular hole diameter, staging, and closure status evaluations. BCVA assessment was performed at baseline and at 1-, 3-, and 6-month follow-up visits after macular hole repair surgery.

“Overall, it is well established that the presence of [intraretinal fluid] is associated with decreased vision in many disease processes,” the study authors explain. “Retina thickness, a surrogate of [intraretinal fluid] volume quantification, has been negatively correlated with visual acuity.”

While correlation between intraretinal fluid area and baseline BCVA was moderate (r, −0.32; P <.001) it was negligible at the postsurgical visits conducted at 1, 3, and 6 months (r, −0.14; P =.026; r, −0.21; P <.001; and r, −0.19; P <.001, respectively), according to the report. Preoperative intraretinal fluid area was strongly correlated with macular hole minimum linear diameter (r, 0.56; P <.001) and base diameter (r, 0.65; P <.001), but no other statistically significant associations were noted.

[T]here still may be some findings where IRF is associated with other MH OCT markers.

The investigators performed an additional analysis to determine the effect of lens status (phakia vs pseudophakia) on correlations between intraretinal fluid area and baseline and 6-month postoperative BCVA. Cyst area correlation with BCVA was not significant at baseline (r, −0.18; P =.15) and was very weak at 6 months following macular hole repair surgery (r, −0.21; P <.001) in patients who were phakic. Cyst area correlation with baseline BCVA was mild (r, −0.37; P <.001) but not significant at 6 months (r, −0.1; P =.69) in patients with pseudophakia, according to the report.

While the team was unable to find clinically-significant correlations between intraretinal fluid area and postsurgical BCVA, “there still may be some findings where [intraretinal fluid] is associated with other [macular hole] OCT markers,” according to the study authors. “This may provide important prognostic information and assist clinicians with decision making and managing patient expectations.”

Study limitations include potential recall bias, a single center design, variations in the time period presurgical scans were performed, and a final analysis performed using 1 reader’s segmentations.


Vatti T, Li H, Singh S, et al. Association of macular hole intraretinal fluid and visual acuityCan J Ophthalmol. Published online June 12, 2023. doi:10.1016/j.jcjo.2023.05.006