Differential diagnosis of macular breaks by microperimetry using the scanning laser ophthalmoscope.

To improve the differential diagnosis of macular breaks by microperimetry using the scanning laser ophthalmoscope (SLO), we studied 50 consecutive breaks detected by biomicroscopy and indirect ophthalmoscopy. The full-thickness macular break was easily diagnosed using only biomicroscopy and indirect ophthalmoscopy because the macular break had a cuff in 22 of the eyes. SLO microperimetry also showed an absolute scotoma within the macular break and a relative scotoma on the cuff in these 22 eyes. However, in the other 28 eyes it was impossible to distinguish between the full-thickness macular breaks and pseudo-macular breaks or lamellar macular breaks using only biomicroscopy and indirect ophthalmoscopy because of the absence of a cuff. However, SLO microperimetry differentiated full-thickness macular breaks from pseudomacular breaks or lamellar macular breaks in these 28 eyes. SLO microperimetry is indispensable for determining the prognosis of and the surgical indication requirements for idiopathic macular breaks.