title: Stage 0 macular holes: observations by optical coherence tomography.
abstract: OBJECTIVE
  To introduce the concept of a stage 0 macular hole based on optical coherence tomographic observations of the vitreoretinal interface in fellow eyes of patients with unilateral idiopathic macular holes, and to evaluate the subsequent risk of progression to a full-thickness macular hole.
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  Ninety-four patients with a unilateral stage 2, 3, or 4 full-thickness macular hole.
  
  
  METHODS
  The medical records of patients with a unilateral macular hole diagnosed between 1994 and 2000 at the New England Eye Center were reviewed.
  
  
  METHODS
  Development of a full-thickness macular hole in the fellow eye on biomicroscopic fundoscopy or optical coherence tomography (OCT).
  
  
  RESULTS
  In 27 (28.7%) of 94 clinically normal fellow eyes, OCT detected an abnormality of the vitreoretinal interface but normal foveal anatomy. The vitreoretinal abnormalities were further subclassified into severe (4 eyes), moderate (8 eyes), and mild (15 eyes) based on the intensity and morphology of the OCT signal. One of the 4 (25%) severe cases progressed to a full-thickness macular hole, 4 of the 8 (50%) moderate cases became full-thickness macular holes, and no (0%) mild cases progressed to a full-thickness macular hole. Severe and moderate eyes seemed to share characteristic features on OCT that increased their risk of macular hole development (stage 0 macular hole). The macular hole-free survival at 48 months was 94% for stage 0-negative patients, versus 54% for stage 0-positive patients. Univariate analysis revealed that the presence of a stage 0 macular hole was significantly associated with an almost 6-fold increase in the risk of macular hole formation (relative risk: 5.8, 95% confidence interval: 1.16-28.61, P = 0.03).
  
  
  CONCLUSIONS
  A stage 0 macular hole has a normal biomicroscopic appearance clinically, but has salient features on OCT as a result of oblique vitreous traction. Optical coherence tomographic findings consist of a normal foveal contour and normal retinal thickness and must include the presence of a preretinal, minimally reflective, thin band inserting obliquely on at least one side of the fovea. The presence of a stage 0 macular hole in the fellow eye is a significant risk factor for the development of a second macular hole.
authors.affiliation: New England Eye Center, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111-1533, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Chan
authors.forename: Jay S
authors.initials: JS
authors.lastname: Duker
authors.forename: Joel S
authors.initials: JS
authors.lastname: Schuman
authors.forename: James G
authors.initials: JG
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological; D018450:Disease Progression; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012167:Retinal Perforations / Q000145:classification / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence / Q000379:methods*