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A. Chan, J.S. Duker, J.G. Fujimoto; Stage Zero Macular Holes: Observations by Optical Coherence Tomography . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1967.
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Purpose: To introduce the concept of a stage zero macular hole based on observations of the vitreoretinal interface in fellow eyes of idiopathic macular holes with optical coherence tomography (OCT) and to evaluate the risk of progression to a full–thickness macular hole. Methods: A retrospective chart review of 94 patients with a unilateral idiopathic full–thickness macular hole was performed. In addition to OCT, patients underwent a comprehensive ophthalmic examination and were followed. Results: The mean follow–up was 41 months (range, 2–142 months). In 27 (28.7%) of 94 fellow eyes, OCT detected an abnormality of the vitreoretinal interface but normal foveal anatomy (stage zero hole). Stage zero holes were further subclassified into severe (4 eyes), moderate (8 eyes), and mild (15 eyes). Of the 27 fellow eyes with a stage zero hole, 5 (18.5%) progressed to a full–thickness macular hole. Of the 67 fellow eyes without a stage zero hole, 3 (4.3%) developed a full–thickness macular hole. The macular hole–free survival at 48 months was 94% for stage zero – negative patients vs. 69% for stage zero–positive patients. Univariate analysis revealed that the presence of a stage zero macular hole was associated with an almost 4–fold increase in the risk of macular hole formation. (RR: 3.8, 95% confidence interval: 0.91–15.91, P=0.07). Conclusions: A stage zero macular hole has a normal biomicroscopic appearance clinically, but has a characteristic appearance on OCT as a result of oblique vitreous traction. OCT findings consist of a normal foveal contour, normal retinal thickness, and the presence of a preretinal, minimally reflective linear signal inserting obliquely into the perifoveal region. The presence or absence of a stage zero macular hole in the fellow eye appears to have prognostic significance for the patient’s risk of bilateral involvement. View OriginalDownload SlideView OriginalDownload Slide
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