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Photo Essay Multimodal imaging of multiple macular holes Aditya Verma, Preet Kanwar Sodhi Key words: Fundus autofluorescence, multiple macular holes, multimodal imaging, optical coherence tomography
A 42‑year‑old male presented with decreased vision in the left eye since 4 years. His best‑corrected visual acuity was 6/6, N6 in the right eye (OD) and 6/36, N36 in the left eye (OS). The anterior segment examination was unremarkable. The fundus was normal for OD, whereas OS revealed three retinal holes over the macula [Fig. 1a and 2a]. The optical coherence tomography (OCT) revealed a normal foveal contour for OD, whereas OS showed two full‑thickness holes over macula (H1 and H2) and a lamellar hole (H3) inferiorly [Figs. 1b, 2b and c, respectively]. H1 and H2 showed central hypoautofluorescence, with a rim of hyperautofluorescence surrounding each hole, an intervening hypoautofluorescence, and an additional outer surrounding rim of dumb‑bell‑shaped hyperautofluorescence [Fig. 3b]. The OD showed a normal fundus autofluorescence [Fig. 3a]. The multifocal electroretinogram (mfERG) showed mildly reduced foveal peak in OD, whereas OS showed reduced responses corresponding to the location of holes [Fig. 4a and b, respectively].
Discussion Multiple macular holes, albeit rare, have been reported in the past.[1‑3] Multimodal imaging helps understanding the pathophysiology and prognosis. The OCT in this case showed the presence of disorganized retinal architecture in the bridging retinal tissue. The central hypoautofluorescence of H1 and H2 was in contrast to what has been observed in the literature and may suggest chronicity. The surrounding hyperautofluorescence is consistent with the outer retinal layer atrophy. H3 showed a uniform hypoautofluorescence, corresponding to the outer retinal atrophy. The mfERG showed reduced responses and depressions corresponding to all the holes. The mild peak in the center confirmed the presence of eccentric fixation of the left eye, located at the intervening retinal tissue between H1 and H2. The etiology was found to be idiopathic and the patient was advised observation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Figure 1: Color fundus picture (a) and optical coherence tomography (OCT) (b) of the right eye. The right eye was normal
Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/ijo.IJO_1092_18 PMID: *****
Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, India Correspondence to: Dr. Aditya Verma, Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai ‑ 600 006, Tamil Nadu, India. E‑mail:
[email protected] Manuscript received: 29.06.18; Revision accepted: 20.09.18
c Figure 2: Color fundus picture (a) of the left eye showing two large full‑thickness holes at the macula and a small lamellar hole just above the inferior arcade vessel. A vitreous floater is also seen. The corresponding OCT scans (b and c) through the holes (along the green arrows) showing the size, location, and extent of the holes, a cuff of subretinal fluid, few cystic spaces at the edges of full‑thickness holes, and disorganized retina in the bridging tissue
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact:
[email protected] Cite this article as: Verma A, Sodhi PK. Multimodal imaging of multiple macular holes. Indian J Ophthalmol 2018;66:1852-3.
© 2018 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
[Downloaded free from http://www.ijo.in on Wednesday, November 21, 2018, IP: 181.129.178.146] Photo Essay December 2018
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Figure 3: Fundus autofluorescence (FAF) images of the right (a) and the left (b) eye. The FAF of the right eye was normal, whereas the FAF in the left eye was typical. The full‑thickness holes showed a central hypoautofluorescence, with a rim of hyperautofluorescence surrounding each hole, an intervening hypoautofluorescence, and an additional outer surrounding rim of dumb‑bell‑shaped hyperautofluorescence. The partial thickness hole showed a uniform hypoautofluorescence
Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
b Figure 4: The multifocal electroretinogram (mfERG) of the right (a) and the left (b) eye. The mfERG of the right eye showed a mild reduced peak in the foveal responses. The mfERG of the left eye showed reduced responses and depressions corresponding to all the holes. The mild peak in the center confirmed the presence of eccentric fixation of the left eye, which was located at the intervening retinal tissue between H1 and H2
References
2. Sandali O, El Sanharawi M, Basli E, Lecuen N, Bonnel S, Borderie V, et al. Paracentral retinal holes occurring after macular surgery: Incidence, clinical features, and evolution. Graefes Arch Clin Exp Ophthalmol 2012;250:1137‑42.
1. Cheng AC, Kwok AK, Bhende P, Lam DS. A case of double idiopathic macular holes. Retina 2000;20:576‑77.
3. Li KK, Lai JS, Wong D. Double macular hole in vitreomacular traction syndrome. Retina 2007;27:648‑50.
Multicolor imaging features of dissociated optic nerve fiber layer after internal limiting membrane peeling
Dissociated optic nerve fiber layer (DONFL) is an after effect of internal limiting membrane (ILM) peeling for macular hole repair.[1] It is thought as a result of damage of Muller cell processes, exposing the retinal nerve fiber layers.[2] Multicolor (MC) imaging available on spectralis spectral domain optical coherence tomography (SDOCT) platform uses three laser lights to provide topographic image of the retina.[3] We herein report the MC imaging characteristics of DONFL.
Kumar Saurabh, Rupak Roy1, Samarth Mishra1, Barun Garg, Sugandha Goel1 Key words: Dissociated optic nerve fiber layer, multicolor imaging, retinal imaging Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/ijo.IJO_783_18 PMID: *****
Retina Services, Kamalnayan Bajaj Sankara Nethralaya, 1Retina Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India Correspondence to: Dr. Kumar Saurabh, Kamalnayan Bajaj Sankara Nethralaya, Dj16, Action Area 1D, New Town, Kolkata ‑ 700 156, West Bengal, India. E‑mail:
[email protected] Manuscript received: 23.05.18; Revision accepted: 22.08.18
A 15‑year‑old boy underwent full‑thickness macular hole repair for traumatic macular hole following blunt trauma with cricket ball. Vitrectomy with ILM peeling and C3F8 gas tamponade was performed following which the best‑corrected visual acuity improved from 20/60 to 20/30 at 1‑month follow‑up. The SDOCT of right eye revealed closing macular hole along with irregular depressions in retinal contour due to thinning of ganglion cell layer
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact:
[email protected] Cite this article as: Saurabh K, Roy R, Mishra S, Garg B, Goel S. Multicolor imaging features of dissociated optic nerve fiber layer after internal limiting membrane peeling. Indian J Ophthalmol 2018;66:1853-4.
