Diagnosis of macular pseudoholes and lamellar macular holes by optical coherence tomography

PURPOSE: To assess the usefulness of optical coherence tomography (OCT) for better differential diagnosis of macular pseudoholes (MPH) and lamellar macular holes (LMH). DESIGN: Observational case series. METHODS: SETTING: Institutional practice. PATIENTS: We reviewed the files of 71 eyes of 70 consecutive patients who were diagnosed as having a pseudohole or lamellar hole on OCT examination. All patients referred for suspected pseudohole or lamellar hole on biomicroscopy were evaluated by OCT. MAIN OUTCOME MEASURES: Each eye underwent six radial 3-mm OCT scans centered on the macula, one 6-mm vertical and one 6-mm horizontal scan. Retinal thickness was measured at the foveal center and 750 mum from the center, vertically, and horizontally. The diameter of the macular contour was also measured on vertical and horizontal scans. RESULTS: In 40 cases, OCT showed a macular profile characteristic of MPH: a steepened foveal pit combined with thickened foveal edges and a small foveal pit diameter. Central foveal thickness was normal or slightly increased (167 +/- 42 mum). Mean perifoveal thickness was greater than normal (363 +/- 65 mum). In 29 other cases corresponding to LMH, OCT showed a profile characterized by a thin irregular foveal floor, split foveal edges, and near,normal perifoveal retinal thickness. Central foveolar thickness was thinner than normal (72 +/- 19 mum). Mean perifoveal thickness was near normal (283 +/- 36). Optical coherence tomography did not allow the classification of the remaining two cases. CONCLUSIONS: Optical coherence tomography is very useful in distinguishing MPH attributable to epiretinal membrane contraction from LMH because of partial opening of a macular cyst. (C) 2004 by Elsevier Inc. All rights reserved.