Optical coherence tomography of the vitreoretinal interface in macular hole formation

Abstract

Aims: To image the vitreoretinal interface and provide further information on the pathogenesis of idiopathic macular hole formation.

Methods: Prospective recruitment of 80 eyes of 41 consecutive patients referred with a diagnosis of idiopathic full thickness macular hole (FTMH) to a teaching hospital retinal clinic. Both eyes of each patient underwent optical coherence tomography (OCT) imaging with vertical and horizontal scans centred on the fovea.

Results: A total of 30 eyes had stage 2 or 3 FTMHs and, of these, 21 had persistent vitreofoveal attachment and associated prefoveal opacities. 18 prefoveal opacities were identified by Goldmann contact lens examination and confirmed on OCT examination. Three prefoveal opacities were identified only on OCT examination. 10 eyes had stage 4 FTMHs and four cases were identified in whom the OCT appearance was consistent with impending, aborted, or lamellar macular holes.

Conclusions: The wide range in OCT appearance of macular holes and associated prefoveal opacities suggests that, in at least some cases, a significant amount of retinal tissue is torn from the foveal area during macular hole formation. OCT imaging provides additional information on macular hole pathogenesis and is valuable in the planning of surgical intervention.

Figure 1

Case 1. Horizontal OCT scan through centre of left fovea with stage 2 macular hole and prefoveal opacity. OCT examination confirms a FTMH with a perifoveal hyaloid detachment and a small prefoveal opacity. The edges of the macular hole appear elevated because of a combination of intraretinal cyst formation and a small cuff of subretinal fluid. HF = hyaloid face, NFL = nerve fibre layer, RPE-Ch = retinal pigment epithelium and choriocapillaris, Ph-OPL = photoreceptors and outer plexiform layer.

Figure 2

Case 2. Horizontal OCT scan through right fovea with stage 3 macular hole (A). OCT confirms a FTMH with partially detached hyaloid face over the temporal macula, remaining attached at the hole rim, continuous with a prefoveal opacity. Horizontal OCT scan though fovea of right eye 3 months postsurgical closure of the hole (B). Case 3. Vertical (C) and horizontal (D) OCT scan through left fovea with stage 2 FTMH. OCT confirms a FTMH with partial detachment of the hyaloid face from the superior macula, remaining attached at the optic disc and inferior edge of the macular hole. A prefoveal opacity is seen in continuity with the posterior hyaloid face.

Figure 3

Case 4. Horizontal OCT scan through centre (A) and just inferior to centre (B) of left fovea with stage 3 FTMH. OCT demonstrates hyaloid face detachment temporally with persistent attachment to a highly reflective prefoveal opacity. (C) is a vertical OCT scan taken through the centre of the macular hole.

Figure 4

Case 5. Horizontal OCT scan of abnormal vitreous attachment in contralateral eye of a patient with a FTMH. OCT shows a shallow perifoveal detachment of the posterior hyaloid face with persistent attachment at the fovea. The fovea is thickened with a possible early intraretinal split.

Figure 5

Case 6. Horizontal OCT scan of aborted bilateral macular holes. OCT demonstrates bilateral partial detachment of the posterior hyaloid face over the fovea, continuous with prefoveal opacities, which is more marked on the right (A) than on the left (B). Case 7. Horizontal OCT scan though fovea of left eye with lamellar macular hole (C). Horizontal OCT scan though fovea of left eye 3 months post surgery (D), OCT shows restoration of foveal architecture consistent with final VA of 6/6. Case 8. Horizontal scan through centre (E) and just inferior to centre (F) of right fovea demonstrating a lamellar macular hole and prefoveal opacity. OCT shows a perifoveal hyaloid detachment with persistent attachment at the fovea. A highly reflective prefoveal opacity is seen in continuity with the hyaloid face overlying an abnormally thin fovea.