Stage 1-A macular hole: a prospective spectral-domain optical coherence tomography study

Retina. 2011 Jan;31(1):127-47. doi: 10.1097/IAE.0b013e3181e7997b.


Purpose: To determine the anatomical morphology of Stage 1-A impending macular holes characterized by a yellow spot using spectral-domain optical coherence tomography to study the fellow eyes of patients diagnosed with a full-thickness macular hole or eyes with a typical yellow spot with metamorphopsia.

Methods: Prospective observational case series of 45 patients with a full-thickness macular hole or a foveolar yellow spot with metamorphopsia. Visual acuity assessment, biomicroscopic examination, and spectral-domain optical coherence tomography were performed. Clinical ophthalmologic examinations were repeated, including spectral-domain optical coherence tomography, in the eyes with a foveolar yellow spot at 1-month interval.

Results: We examined 43 fellow eyes of 43 patients with a macular hole and 2 eyes of 2 patients with a foveolar yellow spot. Five fellow eyes had a yellow spot. Spectral-domain optical coherence tomography clearly showed the reflectivity of the perifoveal posterior vitreous detachment with vitreofoveal adhesion in the 7 eyes with a yellow spot; the foveal microstructure had a triangular foveolar detachment of the cone outer segment tip line, of which only 2 eyes (29%) had foveal splits during the observational period, 3 eyes (43%) had a foveal perpendicular line, and 4 eyes (57%) showed progression to vitreofoveal separation before the development of inner splits or pseudocysts. In those 7 eyes, the 2 eyes (29%) with foveal splits progressed to a full-thickness macular hole. The 38 fellow eyes without a yellow spot had no foveolar detachment.

Conclusion: The foveolar detachment of the cone outer segment tip line might be responsible for the yellow spot seen in Stage 1-A macular holes.

MeSH terms

  • Aged
  • Disease Progression
  • Female
  • Fovea Centralis / pathology
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Retinal Cone Photoreceptor Cells / pathology
  • Retinal Detachment / complications
  • Retinal Perforations / complications
  • Retinal Perforations / diagnosis*
  • Retinal Perforations / physiopathology
  • Rod Cell Outer Segment / pathology
  • Severity of Illness Index
  • Tomography, Optical Coherence / methods*
  • Vision Disorders / complications
  • Vision Disorders / diagnosis
  • Visual Acuity
  • Vitreous Detachment / complications
  • Vitreous Detachment / diagnosis