Diagnosis of macular pseudoholes and lamellar macular holes: is optical coherence tomography the "gold standard"?
OBJECTIVE
To assess fundus autofluorescence (AF) for differential diagnosis of macular pseudoholes (MPH) and lamellar macular holes (LMH) evaluated by optical coherence tomography (OCT) as the "gold standard".


METHODS
The files on 50 eyes of 46 consecutive patients diagnosed by OCT as having a foveal defect with residual retinal tissue at the bottom were reviewed. Retinal thickness was measured at the foveal centre and 750 microm 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: 28 eyes classified with MPH had macular centres and perifoveal retinas that were significantly thicker than the 22 eyes classified with LMH. The corrected value of the foveal AF intensity was not significantly different between the two groups. In addition, the AF did not correlate with the thickness of the retinal tissue at the base of either MPH or LMH eyes. None of the control eyes showed foveal AF.


CONCLUSIONS
The findings suggest that OCT data must be interpreted with caution when differentiating between MPH and LMH. In this series, the two groups showed similar foveal AF. AF imaging may add useful information 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.
Bottoni
F
F
Department of Ophthalmology, S Giuseppe Hospital, Via S Vittore 12, 20123 Milan, Italy. ferdinando.bottoni@fastwebnet.it
Carmassi
L
L
Cigada
M
M
Moschini
S
S
Bergamini
F
F
D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005453:Fluorescence; D005584:Fovea Centralis / Q000473:pathology; D005654:Fundus Oculi; D006801:Humans; D016014:Linear Models; D008266:Macula Lutea / Q000473:pathology*; D009887:Ophthalmoscopy / Q000379:methods; D012160:Retina / Q000473:pathology; D012164:Retinal Diseases / Q000473:pathology; D012167:Retinal Perforations / Q000175:diagnosis*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence