SPONTANEOUS RESOLUTION OF FOVEAL DETACHMENTS AND MACULAR BREAKS

PURPOSE: To evaluate the mechanism of spontaneous resolution of foveal detachments and idiopathic macular breaks. METHOD: We reviewed the re cords of 139 consecutive eyes (94 patients) with either a foveal detac hment or a macular break in patients who were examined between 1989 an d 1992, There were 25 men and 68 women (mean age, 66.9 +/- 6.9 years). They were either unoperated on or observed during the period that pre ceded surgery. Each patient underwent complete ophthalmic examination in addition to slit lamp photography of the vitreomacular interface an d microperimetry with the scanning laser ophthalmoscope. RESULTS: Eigh t eyes demonstrated spontaneous resolution, A foveal detachment was no ted in five eyes (five patients) and a stage 2 macular break in three eyes (three patients). The mean duration of observation was 33 months (range, one to 144 months). Resolution of the foveal detachments occur red without the development of posterior vitreous detachment. In each eye, the presence of a pseudo-operculum, indicating vitreofoveal separ ation, was accompanied by flattening of the foveal detachment without detectable posterior vitreous detachment. The three eyes with stage 2 macular break resolved after premature development of a posterior vitr eous detachment. CONCLUSIONS: Foveal detachment and macular break reso lution seem to result from the release or weakening of vitreous tracti on on the fovea. Reattachment of the foveal retina preserves fair to g ood visual acuity. Surgical intervention is contraindicated (1) in eye s in which foveal detachment flattens and develops a pseudo-operculum and (2) when a posterior vitreous detachment develops in an eye with a stage 2 macular break. Careful biomicroscopic vitreous examination an d microperimetry with the scanning laser ophthalmoscope are extremely useful methods for adequate examination of these patients.