Background: Functional outcome of macular hole (MH) surgery can be better assessed with multifocal electroretinogram (mfERG) and microperimetry (MP). It might provide better assessment than the Snellen visual acuity alone. Objectives: To evaluate macular function with mfERG and microperimetry, and assess their correlation with visual acuity in MH. Materials and Methods: A prospective study was done in patients with unilateral,idiopathic full thickness MH. Standard surgery with vitrectomy, internal limiting membrane peeling and gas tamponade was done. Snellen and logMAR visual acuity, mfERG, microperimetry and optical coherence tomography were done pre and postoperatively. Results: Twenty six patients with unilateral macular hole and twenty five age matched controls were included. The mean age of patients was 59.92±9.39 years (range: 40 to 74 years). All the holes were closed after surgery (two required second surgery). The mean visual acuity improved from 0.77±0.34 logMAR to 0.43±0.36 (p =0.03). The mfERG amplitudes differed ring wise, but the average amplitude changed from 26.31±8.82 to 20.52±7.11 (p =0.03). The mean retinal sensitivity changed from 12.98±2.59 to 13.42±2.53 (p =0.11). There was significant correlation between visual acuity and mfERG amplitudes and retinal sensitivity. Regression equations to predict visual outcome could be derived. Conclusions: In MH, mfERG and microperimetry show reduced responses, delay in recovery of function. They show a strong correlation with visual acuity. It is possible to predict vision after surgery with the help of mfERG and MP. Improved ability to predict visual outcome can increase the utility of anatomic success predictors.

Background: Visual outcome of eyes has often been found to be unsatisfactory even after successful closure of a macular hole, owing to factors like persistent metamorphopsia, scotoma, and reduced sensitivity. Therefore, it becomes critical to evaluate and study the probability and risk of developing a macular hole in the fellow eyes of the patient. This study analyzed the multifocal electroretinographic responses to help predict the risk of macular hole development in fellow eyes. Methods: In total 26 fellow eyes, 26 eyes with macular hole, and 50 eyes of 25 controls were enrolled prospectively. The retinal responses from the different rings were compared in the three groups. Optical coherence tomography was done to rule out macular pathology or vitreomacular traction in the fellow eyes. Results: All the fellow eyes under observation showed significantly reduced mean amplitudes of retinal response densities, in all rings as compared with controls (31.45 ± 10.38 versus 48.87 ± 7.55, p = 0.00). Three of the fellow eyes developed a macular hole during the 24 months observation period. The prevalence of fellow eye involvement was 11.5%. Relative risk of developing macular hole in the fellow eye ranged from 25 to 75. Conclusion: All the fellow eyes, including those that did not develop a macular hole, showed significantly reduced responses on multifocal electroretinogram. This indicates that macular hole may not be a focal disease. It may have widespread functional deficit which is bilateral in nature and suggestive of a degenerative or ischemic insult.