Aim: To assess fundus autofluorescence (AF) for differential diagnosis of macular pseudoholes (MPH) and lamellar macular holes (LMH) evaluated by optical coherence tomography (OCT) as the “gold standard”. Methods: The files on 50 eyes of 46 consecutive patients diagnosed by OCT as having a foveal defect with residual retinal tissue at the bottom were reviewed. Retinal thickness was measured at the foveal centre and 750 μm temporally and nasally to differentiate further MPH and LMH. The corresponding corrected AF images were then evaluated. Eyes with either macular pucker or stage 1a impending macular hole served as controls. Results: OCT measurements allowed the classification of two different profiles: 28 eyes classified with MPH had macular centres and perifoveal retinas that were significantly thicker than the 22 eyes classified with LMH. The corrected value of the foveal AF intensity was not significantly different between the two groups. In addition, the AF did not correlate with the thickness of the retinal tissue at the base of either MPH or LMH eyes. None of the control eyes showed foveal AF. Conclusions: The findings suggest that OCT data must be interpreted with caution when differentiating between MPH and LMH. In this series, the two groups showed similar foveal AF. AF imaging may add useful information to the differential diagnosis of MPH from LMH: the presence of foveal AF is consistent with a loss of foveal tissue and therefore a diagnosis of LMH.

BACKGROUND:To report on the spontaneous closure of a full thickness juxtafoveolar idiopathic macular hole (IMH) monitored with fundus autofluorescence (AF) as well as optical coherence tomography (OCT) imaging.METHODS:Observational case report. Fundus Autofluorescence with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT imaging were used to monitor the spontaneous evolution of a stage II IMH.RESULTS:A 70 year-old woman with unremarkable ocular history received a diagnosis of idiopathic macular hole in the left eye. Bright autofluorescence corresponding to the IMH was documented with the confocal SLO and OCT imaging could confirm the presence of an hour glass shaped full thickness juxtafoveolar IMH. Biomicroscopy revealed no posterior vitreous detachment (PVD). Few months later clinical examination demonstrated the presence of typical symptoms and signs of PVD (miodesopsias and Weiss ring). The bright autofluorescence corresponding to the IMH disappeared and OCT imaging documented a normal fovea in morphology and thickness.CONCLUSIONS:Spontaneous closure of full thickness juxtafoveolar IMH can occur and may be properly monitored with fundus AF as well as OCT imaging.