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Case 9 Diagnosis

Macular hole

Differential Diagnosis

• Macular pseudohole: seen in patients with hole in epiretinal membrane. Look for the classic fine, glistening epiretinal membrane on exam. Clarify diagnosis by directing a slit of light over the macular hole. It will appear wavy to patients with a pseudohole but will be completely absent or broken in those with a true macular hole.
• Solar retinopathy: patients have small, round, red or yellow lesions at the fovea which can also be seen in macular holes. However, there is often a positive history of eclipse-watching or sun-gazing.
• Intraretinal cysts associated with cystoid macular edema: patients often have history of recent ocular surgery, inflammation or diabetes. Fluorescein angiography exhibits early leakage and late-staining in a flower-petal pattern.