Study suggests fundus autofluorescence imaging in addition to OCT for differential diagnosis of foveal defects

Because macular pseudoholes and lamellar macular holes may show similar foveal fundus autofluorescence, optical coherence tomography measurements must be interpreted with caution when differentiating these foveal defects, according to a study published in the May issue of British Journal of Ophthalmology.

"[Fundus autofluorescence] imaging may add useful information to the differential diagnosis of [macular pseudoholes] from [lamellar macular holes]," the authors said. "The presence of foveal [fundus autofluorescence] is consistent with a loss of foveal tissue and therefore a diagnosis of [lamellar macular holes]."

Ferdinando Bottoni, MD, and colleagues at San Giuseppe Hospital in Milan reviewed medical records obtained for 50 eyes of 46 patients who had been diagnosed by OCT as having retinal tissue at the fundus of a foveal defect. The investigators measured retinal thickness at the foveal center and 750 µm temporally and nasally to differentiate further macular pseudoholes (MPH) from lamellar macular holes (LMH). Subsequently, corresponding fundus autofluorescence images were evaluated against controls with macular pucker or stage 1A impending macular holes.

According to OCT measurements, 28 eyes were classified with MPH and 22 eyes were classified with LMH; all MPH eyes had macular centers and perifoveal retinas that were significantly thicker than LMH eyes, the authors noted.

However, there was no significant difference between the corrected value of the foveal fundus autofluorescence intensity between the two groups, they added.

In addition, the investigators found no correlation between the fundus autofluorescence and the thickness of the retinal tissue at the base of either MPH or LMH eyes.

"None of the control eyes showed foveal [fundus autofluorescence]," the authors said.