The extent of stretched lamellar cleavage and visual acuity in macular pseudoholes

Background/aims: To evaluate the extent of lamellar cleavage and its association with preoperative and postoperative visual acuity (VA) in macular pseudoholes. Methods: One eye each of 50 patients with macular pseudohole who underwent vitrectomy was retrospectively investigated. Preoperative macular pseudoholes were evaluated using spectral-domain optical coherence tomography (SD-OCT) images taken radially around the central fovea at 30° intervals. The macular pseudoholes were categorised into stage 1 (no cleavage), stage 2 (localised cleavage with (2b) and without (2a) crossing central fovea) and stage 3 (diffuse cleavage). Results: Among the 50 macular pseudoholes, 14, 13, 9 and 14 were categorised into stages 1, 2a, 2b and 3, respectively. The extent of stretched cleavages was associated with worse baseline VA (p=0.0049 by multiple regression model). After surgery, the stretched lamellar cleavage disappeared in 32 patients out of 36 who were postoperatively examined by SD-OCT. In addition, the extensive cleavage (stage 2b/3) independently predicted larger postoperative VA recovery at 3 months by 0.105 logMAR compared with no/mild cleavage (stage 1/2a, p=0.030 by multiple regression model). Conclusions: Although advanced cleavage in macular pseudohole is associated with worse VA before surgery, even an advanced pseudohole could show favourable visual recovery after surgery.