Papillofoveal traction in macular hole formation - The role of optical coherence tomography

Objectives: To determine the validity of the assumption that optical cohere nce tomographic scans of macular holes have a discrete linear signal (DLS) that represents a detached posterior vitreous face, and to analyze the DLS in macular hole pathogenesis. Methods: Optical coherence tomographic scans were taken of 3 situations in which the vitreous conditions were known: (1) dissected intact vitreous, (2 ) clinically evident Weiss rings, and (3) maculae before and after saccades in eyes without a biomicroscopic posterior vitreous detachment. In additio n, 70 eyes of 35 patients with macular holes underwent clinical examination and optical coherence tomographic scanning that passed through the optic d isc and the fovea or macular hole. Results: Spatial properties of the DLS matched those of the posterior vitre ous face in the situations examined. Of the 70 eyes, 16 (23%) had a biomicr oscopic posterior vitreous detachment, whereas a DLS was demonstrated in 40 (57%). Of the 54 eyes without a biomicroscopic posterior vitreous detachme nt, 18 (33%) had a DLS attached focally to the optic disc margin and the fo vea or macular hole. All 7 of the "can opener" holes examined had a nasally ''hinged" central flap, 6 with a focally attached DLS. Conclusions: The DLS corresponds to the posterior vitreous face. Anteronasa l papillofoveal traction may generate some macular holes.