Differentiating Macular Holes from Macular Pseudoholes

Martinez, Jose A.; Smiddy, William E.; Kim, J.; Gass, J. Donald M.

doi:10.1016/s0002-9394(14)70319-8

Cited by 50 publications

(19 citation statements)

References 26 publications

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“…While in most cases the nature and the stage of a full thickness macular hole are obvious on clinical examination, difficulty in the diagnosis may be experienced even by experienced ophthalmologists 20. In our cases of macular pseudoholes referred for consideration of macular hole surgery, autofluorescence imaging excluded the diagnosis of a FTMH by the absence of central autofluorescence.…”

Section: Discussionmentioning

confidence: 67%

Fundus autofluorescence in patients with macular holes imaged with a laser scanning ophthalmoscope

Rückmann

Fitzke

Gregor

1998

British Journal of Ophthalmology

147

157

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Aim-To demonstrate the usefulness of a recently developed technique of imaging fundus autofluorescence and to compare it with the results of fluorescein angiography in the diagnosis and staging of macular holes. Methods-The intensity and distribution of fundus autofluorescence was studied in 51 patients with idiopathic macular holes and pseudoholes using a confocal laser scanning ophthalmoscope (cLSO) and the images were compared with those obtained by fundus fluorescein angiography. (Br J Ophthalmol 1998;82:346-351) The diagnosis of idiopathic full thickness macular holes (FTMH) is usually made by history and by biomicroscopic examination. However, at times it may be diYcult to diVerentiate between a FTMH and a macular pseudohole even using otherwise reliable clinical tests such as the Watzke-Allen slit beam test. Results-Autofluorescence1 In such cases fluorescein angiography is used but this has the disadvantage of being invasive, requiring an intravenous injection of sodium fluorescein which carries a potential risk of adverse reactions. 2Recently a new technique has been developed that allows in vivo imaging of the distribution of fundus autofluorescence using a confocal laser scanning ophthalmoscope (cLSO).3 This provides high spatial resolution imaging of the distribution of fundus autofluorescence which is most likely derived from lipofuscin within the retinal pigment epithelium.3-5 It is generally accepted that lipofuscin represents the product of degradation of photoreceptor outer segments. In a normal fundus, the distribution of fundus autofluorescence is diVuse, with decreased intensity at the fovea, at the optic nerve head, and under the retinal blood vessels which appear dark.3 4 As this technique images the intrinsic fluorescence of the fundus derived from the retinal pigment epithelium, 3-5 it should be possible to demonstrate a macular defect such as the FTMH similar to that seen on fluorescein angiography.In this study we obtained images of the intrinsic autofluorescence of the fundus with a cLSO in patients with macular holes and pseudoholes and compared the images with those obtained by fluorescein angiography. Material and methodsThe technique of imaging fundus autofluorescence has been described previously.3 4 Briefly the cLSO used in this study was a prototype (SM 30-4024) donated by Zeiss (Zeiss, Oberkochen, Germany). The argon laser (wavelength 488 nm and power of 250 µW) was used for illumination, and to record autofluorescence a filter with a cut oV at 521 nm was inserted in front of the detector. The cLSO images were recorded at standard video scanning rates on SVHS video tape and digitised at 256 × 256 resolution using a Wide Vision V-10 frame grabber (Wild Vision, Tyne and Wear) with an Acorn Archimedes computer (Acorn Computers, Cambridge).A prospective study was undertaken of patients with unilateral idiopathic FTMH and with macular pseudoholes. We deliberately selected only patients with unilateral macular holes in order to compare the autofluorescence images and the...

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Section: Discussionmentioning

confidence: 67%

Fundus autofluorescence in patients with macular holes imaged with a laser scanning ophthalmoscope

Rückmann

Fitzke

Gregor

1998

British Journal of Ophthalmology

147

157

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“…The Snellen acuity was converted into a logarithm of the minimum angle of resolution (logMAR) equivalent to aid statistical analysis 8. A diagnosis of a macular hole was confirmed on slit lamp biomicroscopy by the presence of a full thickness macular defect with a positive Watzke–Allen test 9. Posterior vitreous separation was diagnosed by noting the presence of a visible Weis's ring anterior to the optic nerve.…”

Section: Methodsmentioning

confidence: 99%

Visual and anatomical results of surgery for long standing macular holes

Scott

Ezra²,

West³

et al. 2000

British Journal of Ophthalmology

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Aims-To determine the visual and anatomical outcome of surgery for long standing idiopathic macular holes. Methods-A retrospective review of 24 eyes of all 22 patients who underwent surgery for idiopathic full thickness macular holes (FTMH) symptomatic for between 1 and 3 years. Postoperative follow up was for 6 months. Preoperative and postoperative visual acuities were recorded as well as the presence of anatomical closure of the hole. Results-The mean duration of symptoms was 18.21 (SD 5.42) months). Anatomical closure of the FTMH was achieved in 17 (70.8%) of the eyes at 6 months. The logMAR acuity of the group where closure was achieved improved by a mean of 0.31, equivalent to a change of Snellen acuity from 6/60 to 6/29. Where the hole remained open the acuity deteriorated by a mean logMAR of 0.11 lines, equivalent to a change of Snellen acuity from 6/60 to 5/60. Anatomical closure of the hole was associated with a significantly improved acuity over non-closure (p<0.001). The degree of visual improvement was independent of the preoperative visual acuity (Spearman correlation coeYcient 0.03, p=0.888), though preoperative acuity was related to the final acuity (Spearman correlation coeYcient 0.701, p<0.001). Over the study period, six patients required cataract surgery, one patient developed secondary glaucoma, and one a retinal detachment. Conclusions-Vitrectomy with intraocular gas tamponade and postoperative posturing is a well tolerated and eVective intervention for long standing macular holes. Anatomical closure of the macular hole is associated with a significant improvement in visual acuity. (Br J Ophthalmol 2000;84:150-153) Vitrectomy with fluid-gas exchange is a well recognised and safe technique in the management of idiopathic full thickness macular holes (FTMH).1-3 Most studies demonstrate clear benefits if surgery is performed within 6 months of the onset of symptoms and an inverse relation between the duration of symptoms of FTMH and surgical success in terms of closure and visual acuity has been suggested. The success rate for long standing FTMH is less clear. 6 There are situations where surgery may be considered for patients with long standing FTMH. For example, in patients presenting with bilateral FTMH of long duration or who have had successful surgery on one eye for a FTMH of recent onset on one eye and have a long standing FTMH in the fellow eye. In the latter situation, successful closure of a long standing FTMH may improve overall visual function and stereopsis. 7 Our aim was to evaluate the visual and anatomical eVects of standard vitreous surgery for long standing idiopathic FTMH with symptoms for more than 12 months and less than 36 months. Patients and methodsThis was a retrospective review of 24 eyes (right 54.2%/left 45.8%) of 22 consecutive patients who underwent conventional surgery for idiopathic FTMH symptomatic between 12 and 36 months at Moorfields Eye Hospital from February 1995 to February 1997. The average duration of the macular hole was 18.21 (SD 5.42) mont...

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“…Die detaillierten Ergebnisse sind in . Tab In Zeiten vor klinischer Anwendung der OCT wurde der WAT als ein sehr nützlicher Test zur Diagnosestellung von makulären Veränderungen -klassischerweise von MF -betrachtet und war weit verbreitet [10,12]. Allerdings scheint der WAT auch damals keine sichere Aussage zu dem Bestehen eines Netzhautdefektes geben zu können.…”

Section: Ergebnisseunclassified

“…Nach Durchführung der Funduskopie, des WATs sowie der OCT stellten wir bei 3 Patienten die Diagnose eines Makulaschichtforamens und bei weiteren 4 Patienten die Diagnose einer VMT. Beide Befunde sind fundusko- pisch nicht immer eindeutig von einem durchgreifenden MF zu unterscheiden, der WAT galt hierfür bisher aber als sehr verlässlich [10]. Unsere Studie zeigte aber, dass bei 2 der 3 Patienten mit Makulaschichtforamen und bei allen Patienten mit VMT der WAT positiv ausfiel.…”

Section: Ergebnisseunclassified

“…Während mittelgroße und große MF eine sichere Vitrektomieindikation zur Visusverbesserung darstellen, sind kleine MF und VMT nach der aktuellen Veröffent-lichung der International Vitreomacular Traction Studygroup ebenfalls Indikationen zur enzymatischen Vitreolyse [9]. Zur präoperativen Diagnostik und zur Indikationsstellung ist die OCT-Bildgebung daher unverzichtbar geworden [10,11]. Da aber nicht jeder Augenarzt über ein OCT-Gerät verfügt, könnte der einfach anwendbare Watzke-Allen-Test (WAT) bereits ein hilfreiches erstes Diagnostikum bei verdächtigen Befunden sein.…”

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