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The Role of Optical Coherence Tomography

Devinder S. Chauhan, FRCOphth; Richard J. Antcliff, FRCOphth; Poornima A. Rai, FRCOphth; Tom H. Williamson, MD, FRCOphth; John Marshall, PhD

Arch Ophthalmol. 2000;118:32-38.

Objectives  To determine the validity of the assumption that optical coherence 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 addition, 70 eyes of 35 patients with macular holes underwent clinical examination and optical coherence tomographic scanning that passed through the optic disc and the fovea or macular hole.

Results  Spatial properties of the DLS matched those of the posterior vitreous face in the situations examined. Of the 70 eyes, 16 (23%) had a biomicroscopic posterior vitreous detachment, whereas a DLS was demonstrated in 40 (57%). Of the 54 eyes without a biomicroscopic posterior vitreous detachment, 18 (33%) had a DLS attached focally to the optic disc margin and the fovea 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. Anteronasal papillofoveal traction may generate some macular holes.

From the Department of Ophthalmology, United Medical Schools of Guy's and St Thomas' (Drs Chauhan, Antcliff, and Marshall), and the Vitreoretinal Service, Department of Ophthalmology, St Thomas' Hospital (Drs Rai and Williamson), London, England.

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