**6. Post-op role of OCT: anatomic versus functional success**

	- IS/OS junction is seen as the bright band proximal to the RPE. It is an indicator of photoreceptor alignment.
	- Grade 0: IS/OS junction absent under the fovea.

Grade 1: IS/OS junction present under the fovea (abnormal).

Grade 2: IS/OS junction present under the fovea (normal).

**Figure 8.** Spontaneous resolution of foveal lucency.

It has been noted in various studies that photoreceptor integrity is the best prognostic factor for VA.

Analysis of the inner HRL (hyperreflective layer) allows a better understanding of the outcomes of macular hole surgeries. It has been seen that anatomic success with restoration of foveal contour does not always translate to improved postoperative visual acuity. Irregularities at the level of the inner HRL after macular hole surgery may prevent visual acuity improvement. On the other hand, improvement in BCVA has been noted with IS/OS junction normalization in the postoperative period [23].

	- Flat/open and flat/closed anatomic closure
	- Elevated/open

peel completeness conflicted with iOCT data in 19% of cases (e.g., iOCT displayed a persistent occult residual membrane or showed lack of residual membrane). For posterior segment surgery, it has been reported that the use of iOCT provided valuable feedback in 71% (97 of 136)

The use of iOCT, being in its early stages, has certain limitations—real-time membrane peeling using metallic instruments creates absolute shadowing. Despite this drawback, it is still useful in visualizing tissue-instrument interactions, revealing residual membranes, and con-

This new modality will help improve anatomic and visual outcomes by helping the surgeon ensure completeness of surgical intervention and at the same time minimizing tissue

• IS/OS junction is seen as the bright band proximal to the RPE. It is an indicator of

firming completion of surgical objectives in macular surgery [21, 22].

**6. Post-op role of OCT: anatomic versus functional success**

Grade 1: IS/OS junction present under the fovea (abnormal).

Grade 2: IS/OS junction present under the fovea (normal).

**a.** Photoreceptor inner/outer segment junction

• Grade 0: IS/OS junction absent under the fovea.

photoreceptor alignment.

**Figure 8.** Spontaneous resolution of foveal lucency.

of cases.

90 OCT - Applications in Ophthalmology

manipulation.

The closed macular holes have been variously classified based on OCT

• type 1 closure (closed without foveal neurosensory retinal defect) and type 2 closure (closed with foveal neurosensory retinal defect) (**Figure 9a**) [25]. The extent of postoperative visual improvement of type 1 closure group was larger than that of type 2 closure group. Also, only type 2 closure was associated with recurrence of the pathology. Thus, the postoperative visual prognosis directly correlated to the type of hole closure, which in turn was seen to correspond to the preoperative hole diameter [25].

In another study by Imai et al. [26], OCT images of repaired macular holes were categorized into three patterns (**Figure 9b**).

**Figure 9.** Types of macular hole closure on (a) OCT-Kang et al. [25] and (b) OCT-Imai et al. [26].

• U-type (normal foveal contour)—the retinal pigment epithelium and choriocapillaris layers covered by a smooth surface

**Author details**

Sana I. Tinwala

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Anuditi Eye Care, Mumbai, India

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Address all correspondence to: sanailyas22@gmail.com

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Postoperative acuity was well correlated with these patterns of OCT images.
