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. 1997 Feb;81(2):117–122. doi: 10.1136/bjo.81.2.117

Differentiating full thickness macular holes from impending macular holes and macular pseudoholes

M Tsujikawa 1, M Ohji 1, T Fujikado 1, Y Saito 1, M Motokura 1, I Ishimoto 1, Y Tano 1
PMCID: PMC1722103  PMID: 9059244

Abstract

AIMS—The reliability of scanning laser ophthalmoscope (SLO) microperimetry in differentiating full thickness macular holes from macular pseudoholes and impending macular holes was evaluated.
METHODS—106 eyes with the clinical diagnosis of full thickness macular holes, macular pseudoholes, and impending (stage 1) macular holes were examined for the presence of deep or relative scotoma using SLO microperimetry. The relation between these scotomas and the clinical diagnosis was studied.
RESULTS—Deep and relative scotomas were detected in all 57 eyes with clinically defined full thickness macular holes. In contrast, among 49 eyes diagnosed with macular pseudoholes or impending macular holes, no deep and only one relative scotoma was observed. The sensitivity of the presence of a deep scotoma as an indicator of the clinical diagnosis of a full thickness macular hole was 100% (57 of 57), and the specificity was 100% (49 of 49). The sensitivity of the presence of a relative scotoma was 100% (57 of 57) and the specificity was 98.0% (48 of 49).
CONCLUSION—With SLO microperimetry, full thickness macular holes can be precisely and objectively distinguished from other conditions that mimic macular holes.



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Figure 1  .

Figure 1  

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(A) Fundus photograph of a patient with a full thickness macular hole. (B) Scanning laser ophthalmoscope microperimetry with a 0 dB stimulus from the same patient. The white `A's indicate points seen by the patient, and black `A's correspond to points not seen (deep scotoma). Deep scotoma points were detected within the hole.

Figure 2  .

Figure 2  

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(A) Fundus photograph of a patient with a macular pseudohole. (B) Scanning laser ophthalmoscope microperimetry with a 10 dB stimulus from the same patient. A relative scotoma was not detected.

Figure 3  .

Figure 3  

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Fundus photograph and scanning laser ophthalmoscope (SLO) microperimetry of case 1. A 50-year-old woman presented with a 5 day history of visual loss in her right eye. The initial diagnosis was an impending macular hole. (A) Fundus photograph at presentation. Her best corrected visual acuity was 20/30. (B) Scanning laser ophthalmoscope microperimetry with a 10 dB stimulus at presentation. The white `K's indicate points seen by the patient, and black `K's correspond to points not seen. There is a relative scotoma at the nasal border of the macular hole. (C) Fundus photograph taken 2 months later. Her best corrected visual acuity had dropped to 20/50. The hole had enlarged and the cuff of subretinal fluid surrounding the hole had increased in size. (D) SLO microperimetry performed at that time shows extension of the scotoma to the nasal side of the hole. (E) Fundus photograph of the patient taken 1 month after vitrectomy and gas injection. The hole was closed anatomically. (F) SLO microperimetry recorded 1 month postoperatively. The scotoma had disappeared.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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