the "gold standard"? macular holes: is optical

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Diagnosis of macular pseudoholes and lamellar ... lamellar macular holes (LMH) evaluated by optical coherence ... progression of macular holes,4–8.
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Diagnosis of macular pseudoholes and lamellar macular holes: is optical coherence tomography the "gold standard"? F Bottoni, L Carmassi, M Cigada, S Moschini and F Bergamini Br. J. Ophthalmol. 2008;92;635-639; originally published online 1 Feb 2008; doi:10.1136/bjo.2007.127597

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Clinical science

Diagnosis of macular pseudoholes and lamellar macular holes: is optical coherence tomography the ‘‘gold standard’’? F Bottoni, L Carmassi, M Cigada, S Moschini, F Bergamini Department of Ophthalmology, S Giuseppe Hospital, Italy Correspondence to: Dr F Bottoni, Department of Ophthalmology, S Giuseppe Hospital, Via S Vittore 12, 20123 Milan, Italy; ferdinando. [email protected] Presented in part at the 25th meeting of the Club Jules Gonin, 15-20 October 2006, Cape Town, South Africa Accepted 17 November 2007 Published Online First 1 February 2008

ABSTRACT Aim: To assess fundus autofluorescence (AF) for differential diagnosis of macular pseudoholes (MPH) and lamellar macular holes (LMH) evaluated by optical coherence tomography (OCT) as the ‘‘gold standard’’. Methods: The files on 50 eyes of 46 consecutive patients diagnosed by OCT as having a foveal defect with residual retinal tissue at the bottom were reviewed. Retinal thickness was measured at the foveal centre and 750 mm temporally and nasally to differentiate further MPH and LMH. The corresponding corrected AF images were then evaluated. Eyes with either macular pucker or stage 1a impending macular hole served as controls. Results: OCT measurements allowed the classification of two different profiles: 28 eyes classified with MPH had macular centres and perifoveal retinas that were significantly thicker than the 22 eyes classified with LMH. The corrected value of the foveal AF intensity was not significantly different between the two groups. In addition, the AF did not correlate with the thickness of the retinal tissue at the base of either MPH or LMH eyes. None of the control eyes showed foveal AF. Conclusions: The findings suggest that OCT data must be interpreted with caution when differentiating between MPH and LMH. In this series, the two groups showed similar foveal AF. AF imaging may add useful information to the differential diagnosis of MPH from LMH: the presence of foveal AF is consistent with a loss of foveal tissue and therefore a diagnosis of LMH. In the presence of a foveal defect with relatively well-preserved visual acuity, the question arises of whether we are dealing with macular pseudoholes (MPH) or lamellar macular holes (LMH). The pathogenesis of each is different from the other. MPH are macular lesions that have the appearance of macular holes, but with no loss of foveal tissue. They are attributable to the centripetal contraction of an epiretinal membrane and may be stable. The visual acuity of patients with MPH is usually preserved.1 In contrast, LMH are the result of an abortive process in the formation of a full-thickness macular hole. Clinically, the patient also has relatively well-preserved visual acuity, usually 20/40 or better, and the macula contains a stable, round, and well-circumscribed reddish lesion, but with loss of foveal tissue.2–9 Optical coherence tomography (OCT) evaluation has become useful in the diagnosis of macular holes as it is able to visualise retinal anatomy with near-microscopic resolution (