Foveal Anatomic Changes in a Progressing Stage 1 Macular Hole Documented by Spectral-Domain Optical Coherence Tomography

Objective: To report the case of a stage 1 macular hole and the sequential intrafoveal changes with spectral-domain optical coherence tomography (SD-OCT). Design: Single, observational case report. Participant: A 51-year-old woman with a stage 1A macular hole that progressed to a stage 2 macular hole. Methods: Clinical ophthalmologic examinations were repeated, including SD-OCT, during follow-up at intervals of several weeks. Main Outcome Measures: Sequential intrafoveal tomographic alterations in a patient with a stage 1 macular hole. Foveal splits in the inner retina progressed to an enlarged pseudocyst that disrupted the outer retinal layer (ORL) resulting from the vitreous traction associated with a perifoveal posterior vitreous detachment (PPVD). Results: The patient was referred for decreased vision in the left eye. Her best-corrected visual acuity was 20/32 in the left eye. The SD-OCT showed intrafoveal splits of a typical stage 1A macular hole with a PPVD. Two weeks later, a small, triangularly shaped foveal detachment was detected beneath the central fovea. Four weeks after the initial visit, the splits expanded and the foveal surface was elevated anteriorly; a columnar structure between the splits beneath the central fovea was seen. Eight weeks after the initial visit, the columnar structure was pulled from the outer retina with formation of the PPVD; the structure had shortened anteriorly and formed a cone-shaped structure under the roof. Eleven weeks after the initial visit, the cone-shaped structure shortened and became smaller under the inner roof, and the ORL was separated completely. The anatomic features of the foveal pseudocyst were comparable with that of a typical stage 1B macular hole. Eighteen weeks after the initial visit, the cone-shaped structure disappeared under the inner roof. Thirty weeks after the initial visit, the roof opened with formation of the PPVD. The foveal anatomic features of the full-thickness macular hole became comparable with that of a typical stage 2 macular hole. Conclusions: These OCT findings suggested that the cone-shaped structure was pulled from the outer retina by anteroposterior vitreous traction. This may cause a progressively enlarging pseudocyst that disrupts the ORL in some cases of stage 1 macular holes. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2010;117:806-810 (C) 2010 by the American Academy of Ophthalmology.