Morphological evaluation of full-thickness idiopathic macular holes by optical coherence tomography

Purpose. To assess the efficacy of optical coherence tomography (OCT) for the morphological evaluation of idiopathic full-thickness macular holes and for detecting any morphological changes with time. Methods. Serial sagittal tomographs through the macula were taken by OCT in a consecutive series of 34 eyes of 34 patients with diagnosis of idiopathic full-thickness macular hole. The patients were divided into two groups on the basis of 'recent' ('group 1, 25 patients) or 'not-recent' (group 2, 9 patients) onset of symptoms related to the macular hole. Fourteen of the 25 patients in group 1 and all nine in group 2 underwent vitrectomy. The 11 in group I who refused surgery were observed by OCT examination with follow-up from 6 to 13 months. Results. In most eyes OCT scans revealed two different anatomical features of macular holes depending on the time of onset of symptoms. Eleven of the 14 'recent-onset' holes that underwent surgery showed 'sharp', undermining edges at preoperative OCT; the other three had 'rounded' edges. Seven of the nine eyes operated for long-standing full-thickness macular holes had preoperative 'rounded' edges, while the edges in the remaining two eyes were 'sharp'. OCT of eight of the 11 non-operated eyes in group I showed a morphological evolution of the macular hole edges from a 'sharp' to a 'rounded' contour and an increase in the diameter of the hole. Conclusions. OCT can help in the morphological evaluation of idiopathic full-thickness macular holes and in the detection of morphological changes with time.