Fundus autofluorescence in macular hole surgery

BACKGROUND: Macular holes usually are diagnosed by biomicroscopy. Fluoresce nce angiography (FLA) is helpful especially for judging early stages or pse udoforamina. The importance of fundus-autofluorescence in macular hole surg ery was studied. PATIENTS AND METHODS: Twenty-five consecutive patients with macular holes ( n = 21) and clinically-similar appearances (n = 4) were examined biomicrosc opically. In addition, fundus-autofluorescence and FLA were determined by H eidelberg-Retina-Angiograph (HRA, Heidelberg, Germany). A vitrectomy was pe rformed on 16 patients with macular hole stage II, III, and IV, and membran e peeling was performed if necessary. Platelet-concentrate as an adjuvant a gent was used in all surgeries, and all 16 patients were examined afterward . RESULTS: In all patients with macular hole stage III and IV (n = 18), fundu s-autofluorescence revealed a marked hyperfluorescent spot in the foveolar region and also a hyperfluorescence in FLA. Patients with macular hole stag e II (n = 3) showed a slight punctured hyperautofluorescence and a subtle w indow-defect in the FLA. Postoperatively, the autofluorescence was normal i n all eyes with a closed macular hole (87.5%). In some patients, a variable punctured hyperautofluorescence was noticed (n = 3). In eyes with pseudofo ramina, the autofluorescence was normal (n = 4). CONCLUSION: In macular hole diagnostics, fundus-autofluorescence is able to replace invasive fluorescence angiography. The autofluorescence is helpful for the examination of pseudoforamina and might be useful for estimating t herapeutic success.