title: Stage 1-A macular hole: a prospective spectral-domain optical coherence tomography study.
abstract: OBJECTIVE
  To determine the anatomical morphology of Stage 1-A impending macular holes characterized by a yellow spot using spectral-domain optical coherence tomography to study the fellow eyes of patients diagnosed with a full-thickness macular hole or eyes with a typical yellow spot with metamorphopsia.
  
  
  METHODS
  Prospective observational case series of 45 patients with a full-thickness macular hole or a foveolar yellow spot with metamorphopsia. Visual acuity assessment, biomicroscopic examination, and spectral-domain optical coherence tomography were performed. Clinical ophthalmologic examinations were repeated, including spectral-domain optical coherence tomography, in the eyes with a foveolar yellow spot at 1-month interval.
  
  
  RESULTS
  We examined 43 fellow eyes of 43 patients with a macular hole and 2 eyes of 2 patients with a foveolar yellow spot. Five fellow eyes had a yellow spot. Spectral-domain optical coherence tomography clearly showed the reflectivity of the perifoveal posterior vitreous detachment with vitreofoveal adhesion in the 7 eyes with a yellow spot; the foveal microstructure had a triangular foveolar detachment of the cone outer segment tip line, of which only 2 eyes (29%) had foveal splits during the observational period, 3 eyes (43%) had a foveal perpendicular line, and 4 eyes (57%) showed progression to vitreofoveal separation before the development of inner splits or pseudocysts. In those 7 eyes, the 2 eyes (29%) with foveal splits progressed to a full-thickness macular hole. The 38 fellow eyes without a yellow spot had no foveolar detachment.
  
  
  CONCLUSIONS
  The foveolar detachment of the cone outer segment tip line might be responsible for the yellow spot seen in Stage 1-A macular holes.
authors.affiliation: Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Taiji
authors.initials: T
authors.lastname: Nagaoka
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005584:Fovea Centralis / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017949:Retinal Cone Photoreceptor Cells / Q000473:pathology; D012163:Retinal Detachment / Q000150:complications; D012167:Retinal Perforations / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012374:Rod Cell Outer Segment / Q000473:pathology; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence / Q000379:methods*; D014786:Vision Disorders / Q000150:complications / Q000175:diagnosis; D014792:Visual Acuity; D020255:Vitreous Detachment / Q000150:complications / Q000175:diagnosis