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P.M. Garcia, J.P. Garcia Jr., T.O. Muldoon, A.G. Podoleanu, R.B. Rosen; OCT Ophthalmoscope Characteristics of Macular Holes and Pseudoholes . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3635.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe the unique imaging characteristics of macular holes and pseudoholes using the Optical Coherent Tomography Ophthalmoscope (OCT Ophthalmoscope) Methods: Patients with macular holes and pseudoholes were imaged using the OCT Ophthalmoscope (OCT-SLO, UKC-OTI) ). Longitudinal and coronal scans were taken, and 3D reconstructions were made when possible. The imaging characteristics were then noted, with particular emphasis on unique details that could only be appreciated on coronal sections. Results: Pseudoholes presented in longitudinal scans as a contraction and loss of the gradual foveal depression seen in normal eyes. An abrupt u-shaped excavation is noted in its place. The area surrounding the excavation typically had a slight to marked thickening above the nerve fiber layer, which represents the epiretinal membrane. On coronal scans, this membrane sometimes appeared as striae corresponding to the epiretinal folds, and at other times as a bright, dense area surrounding the small, circular pseudohole. Macular cysts mimic macular holes on direct ophthalmoscopy when cystoid spaces are confluent. With the OCT Ophthalmoscope, the presence of the intact inner and outer retinal layers surrounding these spaces was vividly documented. Epiretinal membranes continuous over pseudoholes could mimic macular cysts, but the OCT Ophthalmoscope could demonstrate the absence of cystoid spaces surrounding the pseudohole. In lamellar holes, cystoid spaces were not seen. They also had sloping excavations as opposed to the u-shaped excavation of pseudoholes. The edges were sharp, and frequently surrounded by a thick epiretinal membrane. True macular holes typically demonstrated round, raised, overhanging edges on longitudinal scans, with cystoid spaces within it. A thick and sometimes irregular RPE layer was noted at the base of the edge. On coronal scans, the cystoid spaces appeared as a halo around the macular hole. Septae were frequently observed within the cystoid spaces, as well as a thickened RPE layer. Conclusions: The OCT Ophthalmoscope offers a unique way of looking at macular holes and pseudoholes. Its high resolution and coronal scanning capabilities enable us to examine these macular changes with more detail than previously possible.
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