Radiating retinal folds detected by scanning laser ophthalmoscopy using a diode laser in a dark-field mode in idiopathic macular holes.

BACKGROUND

The pathogenesis of idiopathic macular hole is unclear. We studied the morphologic features of idiopathic macular holes using a modification of the scanning laser ophthalmoscope (SLO).

METHODS

Seventy-two eyes of 57 patients with macular hole (40 women, 17 men; age 66.1 +/- 6.4 years, mean +/- SD) were included in this study. The macular holes were classified according to the Gass classification (1988). The changes around the macular holes were recorded by SLO using both a confocal aperture with a helium-neon laser (633 nm) and a ring aperture (dark-field mode) with a diode laser (780 nm) to detect fine morphologic features.

RESULTS

We successfully observed minute retinal wrinkling, i.e., radiating striae (fold type) and a dome configuration (dome type), around the macular holes using the SLO dark-field mode with a diode laser, which provides a deeper retinal image because of the longer wave-length laser and the indirect mode. A helium-neon laser with a confocal aperture sometimes failed to disclose the fine retinal wrinkles. Most of the stage 2 macular holes were of the fold type. The smaller the hole, the higher the prevalence of the fold type. As the holes progressed in size, the prevalence of the dome type increased. The radiating retinal folds disappeared after successful vitreous surgery.

CONCLUSION

The SLO dark-field mode with a diode laser might be useful for clear observation of fine retinal features around macular holes. The retinal folds probably indicate the presence of traction on the macula and hence may be good markers for macular repair after vitreous surgery.