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The most recent version of this article was published on 1 May 2008

Br J Ophthalmol. Published Online First: 1 February 2008. doi:10.1136/bjo.2007.127597
Copyright © 2008 by the BMJ Publishing Group Ltd.
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Original article - Clinical Science

Diagnosis of macular pseudoholes and lamellar macular holes: is optical coherence tomography the gold standard?

Ferdinando Bottoni 1*, Luciana Carmassi 1, Mario Cigada 1, Stefania Moschini 1 and Fulvio Bergamini 1

1 Ophthalmology Department, San Giuseppe Hospital, Milan, Italy

* To whom correspondence should be addressed. E-mail: ferdinando.bottoni{at}fastwebnet.it.

Accepted 17 November 2007


*  Abstract

Aims: To assess fundus autofluorescence (AF) for better differential diagnosis of macular pseudoholes (MPH) and lamellar macular holes (LMH) evaluated with optical coherence tomography (OCT) as the gold standard.

Methods: We reviewed the files of 50 eyes of 46 consecutive patients who were diagnosed by OCT as having a foveal defect with residual retinal tissue at the bottom. Retinal thickness was measured at the foveal center and 750 µm 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: twenty-eight eyes classified with MPH had macular centers and perifoveal retinas that were significantly thicker than the twenty-two eyes as classified with LMH. The corrected value of the foveal AF intensity was not significantly different between the two groups. Additionally, the AF did not correlate with the thickness of retinal tissue at the base of either MPH or LMH eyes. None of the control eyes showed foveal AF.

Conclusions: Our findings suggest that OCT data must be interpreted with caution when differentiating between MPH and LMH. In our series both groups showed similar foveal AF. AF imaging may add useful information as 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.

Keywords: Retina, Macula, Imaging, Diagnostic tests/Investigation, fundus autofluorescence, lamellar macular hole, macular pseudohole, optical coherence tomography


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Quantitative Analyses of Fundus Autofluorescence
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BJO Online, 24 Apr 2008 [Full text]
Author's response
Ferdinando Bottoni
BJO Online, 27 May 2008 [Full text]

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