Hyperreflective external limiting membranes after successful macular hole surgery

PURPOSE: To evaluate changes in external limiting membranes (ELMs) in the foveae of patients with surgically closed macular holes. METHODS: In this retrospective observational case series, spectral-domain optical coherence tomography scan images were obtained from eyes of patients with macular holes closed after vitrectomy. The integrity of the ELMs was evaluated at the fovea. In eyes with a restored ELM, the reflectivity of the ELM was estimated. RESULTS: At a mean of 19 months (range, 3.0-59.7 months) after surgery, the integrity of the ELM was restored in 21 (77.8%) of 27 eyes with closed macular holes. The ELM was not restored in six eyes with glial sealing, in which glial tissues were present in the entire retinal layer. All 21 eyes with restored ELMs had an area of hyperreflectivity within the ELM observed at the thinnest part of the fovea; this was associated with an underlying photoreceptor defect. CONCLUSION: Abnormally hyperreflective ELMs were frequently observed at the thinnest point of the fovea after macular hole surgery. These hyperreflective ELMs may be newly formed after surgery.