Diagnosis of macular pseudoholes and lamellar macular holes by optical coherence tomography

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Purpose

To assess the usefulness of optical coherence tomography (OCT) for better differential diagnosis of macular pseudoholes (MPH) and lamellar macular holes (LMH).

Design

Observational case series.

Methods

setting: Institutional practice. patients: We reviewed the files of 71 eyes of 70 consecutive patients who were diagnosed as having a pseudohole or lamellar hole on OCT examination. All patients referred for suspected pseudohole or lamellar hole on biomicroscopy were evaluated by OCT. main outcome measures: Each eye underwent six radial 3-mm OCT scans centered on the macula, one 6-mm vertical and one 6-mm horizontal scan. Retinal thickness was measured at the foveal center and 750 μm from the center, vertically, and horizontally. The diameter of the macular contour was also measured on vertical and horizontal scans.

Results

In 40 cases, OCT showed a macular profile characteristic of MPH: a steepened foveal pit combined with thickened foveal edges and a small foveal pit diameter. Central foveal thickness was normal or slightly increased (167 ± 42 μm). Mean perifoveal thickness was greater than normal (363 ± 65 μm). In 29 other cases corresponding to LMH, OCT showed a profile characterized by a thin irregular foveal floor, split foveal edges, and near-normal perifoveal retinal thickness. Central foveolar thickness was thinner than normal (72 ± 19 μm). Mean perifoveal thickness was near normal (283 ± 36). Optical coherence tomography did not allow the classification of the remaining two cases.

Conclusions

Optical coherence tomography is very useful in distinguishing MPH attributable to epiretinal membrane contraction from LMH because of partial opening of a macular cyst.

Section snippets

Design

This study was an observational case series.

Setting

Institutional practice.

Patients

We retrospectively reviewed the files of 71 eyes of 70 consecutive patients who were examined between 1999 and 2002 and were diagnosed as having a pseudohole or lamellar hole on OCT examination. They included 31 men and 39 women. Their mean age was 67 years (range, 17–85). These patients were referred to our department because, on biomicroscopy, they appeared to have a hole in the macula. On examination, the diagnosis of full-thickness macular hole was ruled out, from the

Results

On biomicroscopy, 49 of the 71 eyes were diagnosed as having MPH. This diagnosis was based on the presence of a well-delineated round or oval image of the macula and in eyes which had a definite ERM with retinal folds. Ten eyes were diagnosed as having LMH combined with a pseudo-operculum. The diagnosis of LMH was based on the presence of a round or petal-shaped reddish lesion with flat edges which was sharply circumscribed. The reddish center seemed slightly depressed, although the depression

Discussion

Macular pseudoholes and LMH are two well-known differential diagnoses of FMTH. As FTMH became a treatable condition, more attention was paid to its characteristics, and Gass9, 10 has thoroughly analyzed the criteria which allow impending or FTMHs to be distinguished from lesions simulating a macular hole. In most cases, careful biomicroscopy slit-lamp examination with a contact lens makes it possible to diagnose FTMH. The Watzke-Allen test11 may be useful when it is frankly positive (i.e., when

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