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Junichi Kiryu, MD; Mahnaz Shahidi, PhD; Yuichiro Ogura, MD; Norman P. Blair, MD; Ran Zeimer, PhD

Arch Ophthalmol. 1995;113(9):1156-1160.

Abstract
Background
The determination of the developmental stage of macular holes is difficult to assess clinically. This may be the reason for the conflicting reports on the risk of vision loss in patients with macular holes and on the value of prophylactic surgery. We have developed a new method, laser biomicroscopy, which provides visualization and photographic record of vitreoretinal structures at the macula.

Objective
To test the applicability of this method to the identification of macular holes stages.

Methods
Laser biomicroscopy and slit-lamp biomicroscopy were used to examine 18 patients with macular holes, identify the lesions, and classify them according to the various stages of development of idiopathic macular holes as proposed by Gass.

Results
Reflections considered to originate from the hyaloid membrane were observed more frequently by laser biomicroscopy than by conventional slit-lamp biomicroscopy. 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 separation was apparent only on laser biomicroscopy. Four cases were selected to illustrate the laser biomicroscopic findings in the different stages of macular hole development.

Conclusions
The ease of visualization of the macular lesions with laser biomicroscopy may facilitate the evaluation of the early stages of macular holes and reduce the incidence of misdiagnosis. Furthermore, photographs obtained by laser biomicroscopy may be a useful tool in studies of early stages of macular holes.

Author Affiliations
From the Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago College of Medicine. Dr Zeimer is now with The Johns Hopkins Hospital, Baltimore, Md. Dr Zeimer is entitled to sales royalty from Talia Technology Inc, which is developing products related to the research described in this article. In addition, he serves as a consultant to Talia Technology Inc. The terms of this arrangement have been reviewed and approved by the University of Illinois at Chicago and The Johns Hopkins University in accordance with their conflict of interest policies.

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