FUNDUS PHOTOGRAPHIC AND FLUORESCEIN ANGIOGRAPHIC CHARACTERISTICS OF PSEUDOHOLES OF THE MACULA IN EYES WITH EPIRETINAL MEMBRANES

Background: The fluorescein angiographic characteristics in eyes with pseudoholes of the macula associated with epiretinal membranes have no t been studied extensively. Methods: Stereo photographs and fluorescei n angiograms from 83 consecutive eyes of 80 patients with pseudoholes of the macula were evaluated by two independent graders for epiretinal membrane opacity, fluorescence in the base of the pseudohole, and lat e perifoveal pooling of dye. Results: Hyperfluorescence in synchrony w ith choroidal fluorescence appeared within the base of the pseudohole in 52 (63%) of the 83 eyes studied. The hyperfluorescence was smaller than the pseudohole in 37 (45%) eyes. Diffuse hyperfluorescence filled the pseudohole in 15 (18%) eyes. No fluorescence was seen in 20 (24%) eyes. Eleven (13%) eyes could not be graded due to coexistent macular disease or media opacity. Fluorescence within the area of pseudohole was less common in eyes with opaque epiretinal membranes than in eyes with visible or transparent epiretinal membranes (P = 0.002). Fluoresc ence within the area of the pseudohole was also less common in eyes wi th evidence of macular edema on fluorescein angiography (P < 0.001). T he mean Visual acuity was better for eyes with hyperfluorescence withi n the area of the pseudohole than for eyes without hyperfluorescence ( P < 0.01). Conclusion: A common fluorescein angiographic characteristi c associated with pseudoholes of the macula is early hyperfluorescence within the area of the pseudohole. This hyperfluorescence coincides w ith choroidal filling and appears to be a form of transmission defect rather than a blocking of surrounding choroidal fluorescence by the ep iretinal membrane. This central hyperfluorescence may result in misdia gnosis of the macular pseudohole as a full-thickness macular hole.