Fixation patterns of idiopathic macular holes after vitreous surgery

Background: Evaluation of idiopathic macular holes with the scanning laser ophthalmoscope (SLO) has shown fixation to be located at or near the margin of the hole and above the horizontal meridian in most cases. However, chan ges between preoperative and postoperative fixation have not been well stud ied. Method: We used SLO microperimetry to determine scotomas and fixation point s in 13 patients with idiopathic macular holes before and after vitreous su rgery. The distance between preoperative and postoperative fixation points and the direction of movement were measured, Results: Preoperatively, fixation was found to be at or near the margin of the macular hole in all eyes and was located above the horizontal meridian in most (84.6%) eyes. Postoperatively, there was a shift in the position of the fixation points. The distance between preoperative and postoperative f ixation correlated with the degree of visual improvement (P = 0.032), but t he direction of movement was variable. Conclusion: A shift in the position of fixation occurs after macular hole s urgery, and the amount of shift correlates with visual improvement, From th is observation, we define the term functional macular hole closure, charact erized by centripetal movement of the neurosensory retina and improvement i n vision, and the broader term anatomic macular hole closure, in which appa rent hole closure may result from gliosis in the absence of movement of the neurosensory retina, not associated with visual improvement.