Purpose: 

To investigate the interrelationship among the outer retinal layers after macular hole surgery and elucidate the restoration process.

Methods: 

This retrospective observational study included 50 eyes of 47 consecutive patients with closed macular holes in the first vitrectomy. Optical coherence tomography was obtained before surgery; at 1, 3, and 6 months postsurgery; and at the last visit. The complete continuous layer rate and mean defect length were evaluated for the outer nuclear layer (ONL), external limiting membrane (ELM), and ellipsoid zone (EZ).

Results: 

At all postoperative visits, the complete continuous layer rate was in the descending order of ELM, ONL, and EZ and the mean defect length was in the ascending order of ELM, ONL, and EZ. External limiting membrane was necessary for ONL restoration. External limiting membrane and ONL were necessary for EZ restoration. Hyperreflective protrusions were observed from the area lacking ELM into the subretinal space after surgery. Ellipsoid zone was not formed in coexistence with the hyperreflective protrusions. Intermediate reflective protrusions appeared under the ONL plus ELM after surgery and were eventually replaced by EZ.

Conclusion: 

Restoration of the outer retinal layers after surgical macular hole closure occurs in the order of ELM, ONL, and EZ.

中文翻译：

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黄斑裂孔闭合术后视网膜外层的修复过程

目的： 

探讨黄斑裂孔术后视网膜外层之间的相互关系，阐明修复过程。

方法： 

这项回顾性观察研究包括 47 名连续第一次玻璃体切除术中黄斑裂孔闭合患者的 50 只眼。术前获得光学相干断层扫描；术后 1、3 和 6 个月；并在最后一次访问时。评估了外核层 (ONL)、外部限制膜 (ELM) 和椭球区 (EZ) 的完整连续层率和平均缺陷长度。

结果： 

在所有术后就诊中，完全连续层率按ELM、ONL和EZ的降序排列，平均缺损长度按ELM、ONL和EZ的升序排列。ONL 修复需要外界膜。EZ 修复需要外界膜和 ONL。术后观察到从缺乏 ELM 的区域进入视网膜下腔的高反射突起。椭球区没有与高反射突起共存。手术后ONL加ELM下出现中间反光突起，最终被EZ取代。

结论： 

手术黄斑裂孔闭合后视网膜外层的恢复按照 ELM、ONL 和 EZ 的顺序进行。