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