The authors had reported the phenomenon of foveal tissue elongation and its impact on metamorphopsia after macular hole (MH) surgery. Through this following study, we would like to present the clinical implications of notching sign in the parafoveal tissue after MH surgery.


This study involved 35 eyes from 35 patients who underwent surgery for MH. Notching of tissue was defined as an abrupt alteration in the inner contour of the parafoveal tissue, based on postoperative optical coherence tomography image (OCT) image. The distance between the parafoveal edges of the outer plexiform layer (OPL) was defined as the inter-OPL distance. The inter-OPL distance was divided into nasal and temporal, or superior and inferior lengths. The lengths of the four directions were classified into two groups according to the presence or absence of notching of tissue. The difference in the lengths of each direction, that is, the amount of foveal tissue elongation between the early and late postoperative period was compared between the two groups.


The early and late postoperative examination was performed at 5.4 ± 4.5 (mean ± standard deviation) weeks and 6.6 ± 0.8 months, respectively. Notching of tissue was noted in 26 of 35 eyes (74.3%). In 22 eyes with a measurable inter-OPL distance, the notching of tissue was noted in 17 of 22 eyes (77.3%) and in 37 of 88 directions (42.0%) regardless of preoperative MH size. The mean amount of foveal tissue elongation that occurred during the designated period was 82.4 ± 72.1 μm and 47.9 ± 60.6 μm in the directions with and without the notching of tissue (P=0.017), respectively.

As a conclusion:

These results indicate that notching in the parafoveal tissue could be a diagnostic marker for the development of foveal tissue elongation after MH surgery. The presence of notching in the majority of eyes, regardless of preoperative size of MH, suggests that elongation of the foveal tissue is a generalized phenomenon after MH surgery. Further study to prevent the development of foveal tissue elongation and notching sign would be warranted.