Macular hole case 3.

<p>Images of the left eye of a 36-year-old woman with surgically closed MH with a Snellen equivalent BCVA of 20/20 (improved from a presurgical BCVA of 20/70 as a result of stage 4 MH). <b>A,</b> Fundus photography shows a closed MH. <b>B,</b> An infrared image with green arrows indicating the directions of the scans producing the images in D and E, and a white box indicating the extent of the double-headed arrows in D and E. <b>C</b>, Microperimetry shows relative scotoma. <b>D</b> and <b>E,</b> SD-OCT images. <b>D,</b> A horizontal-line scan through the center of the fovea, taken in the direction of the horizontal arrow in B, revealing that the line representing the IS/OS junction is intact, whereas the line representing the cone outer segment tip (COST) is disrupted (blue arrowhead). ELM: external limiting membrane, ONL: outer nuclear layer, RPE: retinal pigment epithelium. Scale bar = 1000 µm. <b>E,</b> A vertical-line scan through the center of the fovea in the direction of the vertical arrow in B, demonstrating that the IS/OS junction is almost continuous, whereas COST is disrupted (blue arrowheads). Scale bar = 1000 µm. <b>F,</b> AO-SLO images of the area indicated by the white box in B and the double-headed arrows in D and E showing irregular dark regions (yellow arrows). Note that dark regions are seen beside and within the foveola but are not seen in the center of the fovea. Dark regions correspond to the area of COST disruption on SD-OCT (D and E). Scale bar = 200 µm. <b>G</b>, A high-magnification view that includes the foveola. <b>H</b>, Automated detection of cone loss area. The circle indicates the foveola. Dim pixels with its reflectivity below the threshold are shown in green and red depending on whether they are located inside or outside of the circle, respectively. Cone loss ratio in the foveola was 48.62%.