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Jason Comander, Matthew Gardiner, John Loewenstein; High Resolution Optical Coherence Tomography Findings in Solar Maculopathy and the Differential Diagnosis of Outer Retinal Holes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2163. doi: https://doi.org/.
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Solar maculopathy from sungazing can cause permanent scotomas and visual loss. This condition can be caused by unprotected viewing of solar eclipses, in the psychiatric population, and after recreational drug use. While solar maculopathy is classically recognized ophthalmoscopically as a small, multifaceted outer retinal hole, SD-OCT provides the opportunity to more easily diagnose this condition.
A case series of three patients (6 eyes) with chronic solar maculopathy is presented. A case series of SD-OCT findings in this rare and unusual condition has yet to be reported. Comparison is made to SD-OCT findings in simulating conditions.
OCT demonstrates a characteristic appearance of partial thickness hole(s) in the outer retina at the fovea. In three of six eyes, there is one hole directly beneath the umbo. In the remaining three eyes, there are multifocal holes spread across the fovea. Holes in more restricted layers, as had been previously reported with time-domain OCT, were not seen. In addition, advanced visualization of SD-OCT data demonstrates a newly reported feature- a hyperreflective ring around the outer retinal hole.
SD-OCT can be used diagnose solar maculopathy. In patients with central scotomas, characteristic outer retinal hole(s) without inner retinal cystic changes may prompt the clinician to uncover an undisclosed history of sungazing. Similar OCT findings can be caused by welder’s maculopathy, tamoxifen retinopathy, juxtafoveal macular telangiectasia, foveolar vitreomacular traction, or rarely, a closed macular hole or Stargardt’s disease. Differentiating features of these conditions are discussed. New information from this study includes: the description of a hyperreflective ring around the outer retinal hole(s), which presumably represents cellular debris; the demonstration in multiple patients that holes in limited layers of the retina reportedly seen using time domain OCT are not visible using SD-OCT; and a synthesis of recently reported data on the SD-OCT appearance of simulating conditions that helps in determining the etiology of outer retinal holes.
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