SERIAL OPTICAL SECTIONING OF MACULAR HOLES AT DIFFERENT STAGES OF DEVELOPMENT

Objective: This study aimed to examine the characteristics of intraret inal changes associated with macular holes and epiretinal membranes by scanning retinal thickness analysis. Study Design: The study design w as a nonconsecutive case series. Patients: Fifty-six eyes of patients who had either a suspected or clinically diagnosed macular hole or epi retinal membrane were recruited. Interventions: A commercial prototype of the scanning retinal thickness analyzer (RTA) was used. It project ed a laser slit beam onto the retina and scanned it, in 200 or 400 mse c, across a 2- x 2-mm area, yielding multiple optical cross sections t hat were recorded digitally. Results: Epiretinal membranes were detect ed, and sites of attachment could be identified. Full-thickness holes corresponded to intraretinal cavities in which the inner retinal surfa ce was broken, usually at the center. The majority of eyes with full-t hickness macular holes showed increased retinal thickness surrounding the hole. The so-called ''cuff of subretinal fluid,'' however, often w as not present by retinal thickness analysis, despite clinical diagnos is to the contrary, even though retinal thickness analysis is capable of detecting such fluid. In 20 (42%) of 47 eyes diagnosed or suspected of having macular holes, scanning retinal thickness analysis showed f indings different from those reported by retinal specialists. Conclusi ons: Examination of macular holes with the scanning RTA provides usefu l information in the diagnosis of macular holes in addition to that ob tained through conventional techniques, The findings support the idea that many macular holes develop in association with intraretinal cysti c changes. The precise chronology of the events remains to be determin ed.