Fundus autofluorescence related to retinal morphological and functional changes in idiopathic macular holes

To investigate fundus autofluorescence (FAF) characteristics in relation to morphological and functional features of idiopathic macular hole (IMH).

Twenty eyes of 20 consecutive patients with stage 3 or 4 macular holes were included. Fundus autofluorescence images were obtained using the Heidelberg retina angiograph 2, retinal structure was evaluated with 3-dimensional (3-D) imaging of Fourier-domain optical coherence tomography (FD-OCT), and retinal function was assessed with microperimetry-1 (MP-1).

Markedly increased FAF in the foveal centre corresponding to the macular hole, confirmed with FD-OCT, was demonstrated in all eyes. A surrounding hypoautofluorescent ring corresponded to the subretinal fluid cuff. The area of relatively reduced FAF around the ring corresponded precisely to retinal oedema. In 15 eyes (75%), a stellate appearance with dark radiating striae was seen in the relatively reduced FAF and was correlated with intraretinal cystic changes in the outer plexiform layer, observed by FD-OCT. Mean preoperative visual acuity was significantly poorer in eyes without a stellate appearance than in those with a stellate appearance (p = 0.023). The MP-1 study confirmed impaired retinal function in the macular hole bed and in the area of the fluid cuff and retinal oedema.

Fundus autofluorescence imaging reflects anatomic changes and represents the dysfunctional retinal area in IMH. The technique provides 2-D images with 3-D information on the retinal morphology of this disease.