Clinical Summary

A 75-year-old man was referred for evaluation of a macular abnormality resembling a macular hole in his left eye. He had previously undergone successful cataract surgery in this eye and his visual acuity was 20/25. Dilated fundus examination (A) revealed an oval shaped region in the fovea ophthalmoscopy Uv similar to a hole, a mild epiretinal membrane, and some tortuousity in the papillomacular bundle. Fluorescein angiography (B) was normal except for a small amount of late leakage in the perifoveal area.

Optical Coherence Tomography

OCT examination (C) demonstrated an abnormally steep foveal contour resembling a partial thickness hole with a diameter of approximately 500 pm The minimally reflective outer retinal layer corresponding to the retinal photoreceptors appeared intact throughout the image, ruling out a full-thickness macular hole. A significant increase in retinal thickness was noted in the macula, reaching a maximum of 570 Jim in the tomogram. The epiretinal membrane was not clearly distinct from the neurosensory retina in the OCT image, presumably because of its tight apposition with the inner retina.


Epiretinal Macular Membranes

Case 4-2. Macular Pseudohole

Clinical Summary

An 82-year-old man had a persistent epiretinal membrane in the right eye, with a visual acuity of 20/80. Five years earlier he had undergone treatment with pars plana vitrectomy and membrane peeling. Dilated ophthalmoscopy (A) showed a reproliferation of the membrane and an associated central defect consistent with a macular pseudohole. Fluorescein angiography (B) demonstrated earlv hyperfluorescence with fading in the late phase consistent with a window defect.

Optical Coherence Tomography

An OCT tomogram (C) obtained through the pseudohole showed a lesion resembling a macular hole with an inner diameter of approximately 650 Jim, The presence of retinal tissue at the base of the hole, however, confirmed the clinical diagnosis of epimacular membrane and an associated pseudohole. The outer neurosensory retinal tissue within the pseudohole appeared condensed, exhibiting reduced thickness and increased backscattering compared to the adjacent photoreceptors. Minimal retinal thickening was observed in the surrounding tissue, which reached a maximum of 470 jam in the image- The epiretinal membrane was not distinctly visible in the tomogram and was most likely tightly adherent to the inner retinal surface.

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