ILLUSTRATION OF THE STAGES OF IDIOPATHIC MACULAR HOLES BY LASER BIOMICROSCOPY

Background: The determination of the developmental stage of macular ho les is difficult to assess clinically. This may be the reason for the conflicting reports on the risk of vision loss in patients with macula r holes and on the value of prophylactic surgery. We have developed a new method, laser biomicroscopy, which provides visualization and phot ographic record of vitreoretinal structures at the macula. Objective: To test the applicability of this method to the identification of macu lar holes stages. Methods: Laser biomicroscopy and slit-lamp biomicros copy were used to examine 18 patients with macular holes, identify the lesions, and classify them according to the various stages of develop ment of idiopathic macular holes as proposed by Gass. Results: Reflect ions considered to originate from the hyaloid membrane were observed m ore frequently by laser biomicroscopy than by conventional slit-lamp b iomicroscopy. Two fellow eyes were diagnosed by laser biomicroscopy as having stage 1 lesions while slit-lamp biomicroscopy failed to yield a clear diagnosis. In four eyes with stage 3 holes the vitreoretinal s eparation was apparent only on laser biomicroscopy. Four cases were se lected to illustrate the laser biomicroscopic findings in the differen t stages of macular hole development. Conclusions: The ease of visuali zation of the macular lesions with laser biomicroscopy may facilitate the evaluation of the early stages of macular holes and reduce the inc idence of misdiagnosis. Furthermore, photographs obtained by laser bio microscopy may be a useful tool in studies of early stages of macular holes.