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Raffaele Perrotta, Sylvia Marchi, Alessandro Invernizzi, Giovanni Staurenghi; Different Features in Autofluorescence of Full Tickness Macular Hole Using Three Different Scanning Confocal Laser. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2199.
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To evaluate the features of fundus autofluorescence (FAF) in full thickness macular hole (FTMH) using three confocal scanning laser ophthalmoscope (SLO) with different excitation wavelenghts.
We retrospectively reviewed FAF images of 5 patients with FTMH stage IV according to Gass biomicroscopy classification. To confirm the diagnosis all patients underwent an OCT examination using HRA+OCT Spectralis (Spectralis OCT, Heidelberg Engineering, Germany). Then to investigate the posterior pole FAF we used Heidelberg HRA+OCT Spectralis, Canon CX-1 (Canon INC., Tokio, Japan), and Zeiss 450 (Carl Zeiss AG, Jena, Germany).The excitation wavelenghts of the three instruments are, respectively, 488 nm, 500 nm and 510-580 nm.
FAF derives from the lipofuscin-laden retinal pigment epithelium (RPE) and in the macula it is attenuated by the luteal pigment. The FAF using Heidelberg HRA+OCT Spectralis revealed a black halo of hypofluorescence surrounding the macular hole due to the masquerading effect of macular luteal pigments, of the subretinal fluid and/or of the thickening of the neurosensory retina which attenuates the light that reaches the retinal pigment epithelium. The lack of the outer plexiform layer in the fovea and the absence of masking pigment allows the autofluorescence originating from the RPE to be easily detected.On the other hand, the different wavelenghts of the confocal SLOs Canon CX-1 and Zeiss 450 is not adsorbed by luteal pigments or by the tickening of the edges of the macular hole, thereby showing an hyperfluorescent halo surrounding FTMH.
The use of FAF for studying FTMH and for monitoring their aspect after surgery must be interpreted with caution: the different wavelenghts of stimulating light show different patterns that should be considered.
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