Morphological Characteristics May Show Photoreceptor Disruption in Macular Hole

The presence of supra-retinal pigment epithelium (RPE) granular deposits and a bumpy morphology may be signs of photoreceptor disruption in patients with full-thickness macular hole (MH), according to a retrospective case series published in the American Journal of Ophthalmology. A bumpy morphology may be an indicator of irreversible photoreceptor damage, according to the report. 

Researchers reviewed clinical charts and multimodal images of 149 eyes from 143 consecutive patients (mean age, 68.6 years; 89 women) with full-thickness MH, treated surgically and with at least 12 months of follow-up. The research team identified supra-RPE granular deposits in 121 out of 149 eyes (81.2%). A smooth morphology was detected in 58 out of 149 eyes (38.9%), and a bumpy border was detected in 91 out of 149 eyes (61.1%).

The researchers found that photoreceptor disruption was mostly located close to the MH aperture. In 8% of the cases, the team observed preoperative anatomical progression from smooth to bumpy morphology.

The presence of supra-RPE granular deposits was associated with a significantly lower postoperative best corrected visual acuity (BCVA) solely in the univariate analysis (P <.001). In both univariate and multivariate analysis, the presence of a bumpy border was significantly associated with lower postoperative BCVA (P <.001).

BCVA gain was significantly worse in MH with bumpy borders (P <.001), according to the report. The presence of a bumpy border was also significantly associated with inferior postoperative anatomical restoration (P <.001). 

“Supra-RPE granular deposits are likely remnants of degraded photoreceptor outer segments containing lipofuscin precursors. This abnormality alone may be an early sign of potentially reversible photoreceptor disruption,” according to the researchers. “A bumpy morphology of MH borders was often associated with the presence of supra-RPE granular deposits and may signify deeper and potentially irreversible photoreceptor damage.”

Study limitations include its retrospective nature, the use of en-face imaging in only a small subgroup of patients, and a relatively short follow-up period. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.