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Sequential En Face Spectral-Domain Optical Coherence Tomographic Analysis of Macular Hole Formation

Michael F. Clamp, MD1; J. Michael Jumper, MD2; H. Richard McDonald, MD2; Arthur D. Fu, MD2; Brandon J. Lujan, MD2,3
[+] Author Affiliations
1Department of Ophthalmology, California Pacific Medical Center, San Francisco
2West Coast Retina Medical Group, San Francisco, California
3Department of Vision Science, School of Optometry, University of California, Berkeley
JAMA Ophthalmol. 2015;133(4):486-488. doi:10.1001/jamaophthalmol.2014.5510.
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Idiopathic macular hole is a condition widely believed to result from disruption of retinal tissue due to anteroposterior vitreofoveal traction.1 Previous reports have used spectral-domain optical coherence tomography (SD-OCT) to demonstrate cross-sectional images of macular hole formation in the setting of vitreomacular traction.13 Herein, we present sequential en face SD-OCT analysis of an evolving macular hole to attempt to elucidate its pathogenesis.

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Figure 1.
Cross-Sectional and En Face Spectral-Domain Optical Coherence Tomographic Images

A, Baseline imaging. B, At presentation 1 year later, imaging confirmed a stage 1A macular hole. C, Four days after discovery of the stage 1A macular hole, the pseudocyst appeared smaller, the roof was flattened, and the horizontal area of the pseudocyst had decreased. D, Two weeks after discovery of the stage 1A macular hole, the pseudocyst had expanded posteriorly to involve the photoreceptor bands, the external limiting membrane, and the outer nuclear layer. E, Three weeks after discovery of the stage 1A macular hole, a stage 2 full-thickness macular hole was present and there was a newly formed partial ring of septated, radial cystoid abnormalities extending from the perimeter of the macular hole within the Henle fiber layer. Column I shows horizontal scans; column II, en face slab position; column III, en face images of the turquoise slab from column II centered on intraretinal cystoid abnormalities; and column IV, en face images of the red slab from column II centered on outer photoreceptor bands.

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Figure 2.
Cross-Sectional Image With En Face Overlay

Outer plexiform layer (solid arrows) and external limiting membrane (dashed arrows) are shown. The spokes of the wheel and intervening cystoid abnormalities exist within the Henle fiber layer, which is composed of photoreceptor axons and Müller cell processes. N indicates nasal; T, temporal. The turquoise and red lines represent the position and thickness of the slabs through the Henle fiber layer and outer photoreceptor bands, respectively.

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