Clinical features of idiopathic preretinal macular fibrosis. Schoenberg Lecture.

Of 150 consecutive cases of preretinal macular fibrosis that occurred predominantly in older subjects, 118 cases involved only one eye while 32 occurred binocularly. The ratio of women to men was 3:2. Visual acuity was usually 20/50 or better, and only four of 178 eyes had acuity below 20/200. The vast majority of lesions involved the macula and few extended outside the macular zone. The characteristic clinical finding on ophthalmoscopy was a glinting reflex probably due to a layer of connective tissue cells lying on the internal limiting membrane. Small white exudates, venous abnormalities, and occasional hemorrhages may also be part of prepretinal macular fibrosis. Amsler grid testing usually demonstrated irregularity and distortion of some part of the grid. Fluorescein angiography revealed a characteristic tortuosity of the small macular vessels. Most eyes had previous posterior vitreous detachments but, except for one possible case, there were no cases where the posterior vitreous body was adherent to either the retinal membrane or the macular region. There was no significant systemic disease related to preretinal macular fibrosis. In most instances, preretinal macular fibrosis either was stationary or slowly progressive. The etiology and treatment of the condition remains obscure.