Papillofoveal traction in macular hole formation: the role of optical coherence tomography.
OBJECTIVE
To determine the validity of the assumption that optical coherence tomographic scans of macular holes have a discrete linear signal (DLS) that represents a detached posterior vitreous face, and to analyze the DLS in macular hole pathogenesis.


METHODS
Optical coherence tomographic scans were taken of 3 situations in which the vitreous conditions were known: (1) dissected intact vitreous, (2) clinically evident Weiss rings, and (3) maculae before and after saccades in eyes without a biomicroscopic posterior vitreous detachment. In addition, 70 eyes of 35 patients with macular holes underwent clinical examination and optical coherence tomographic scanning that passed through the optic disc and the fovea or macular hole.


RESULTS
Spatial properties of the DLS matched those of the posterior vitreous face in the situations examined. Of the 70 eyes, 16 (23%) had a biomicroscopic posterior vitreous detachment, whereas a DLS was demonstrated in 40 (57%). Of the 54 eyes without a biomicroscopic posterior vitreous detachment, 18 (33%) had a DLS attached focally to the optic disc margin and the fovea or macular hole. All 7 of the "can opener" holes examined had a nasally "hinged" central flap, 6 with a focally attached DLS.


CONCLUSIONS
The DLS corresponds to the posterior vitreous face. Anteronasal papillofoveal traction may generate some macular holes.
Chauhan
D S
DS
Department of Ophthalmology, United Medical Schools of Guy's and St Thomas', London, England. chauhands@aol.com
Antcliff
R J
RJ
Rai
P A
PA
Williamson
T H
TH
Marshall
J
J
D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology*; D012167:Retinal Perforations / Q000175:diagnosis / Q000209:etiology*; D012438:Saccades; D000267:Tissue Adhesions; D014054:Tomography / Q000379:methods*; D020255:Vitreous Detachment / Q000150:complications* / Q000175:diagnosis