Full-Thickness Macular Hole Formation after Internal Limiting Membrane Peeling: Beware the “Omega Sign”

Figure 2

(a) Infrared reference image and (b) foveal SDOCT raster scan of the right macula. Infrared imaging showed hyperintensity within areas of nasal macular schisis within Henle’s layer and hypointensity in areas temporally with serous retinal detachment. The foveal center appears hyperintense from transmission defect. Schisis involved the photoreceptor and outer plexiform layers with intact nerve fiber layer. (c) Lateral displacement of the photoreceptors produced the “omega sign” on SDOCT, highlighted in yellow, indicating that only the Müller cell cone was bridging the foveola. (d) SDOCT foveal raster scan six weeks after PPV with ILM peeling shows FTMH 5 contiguous with resolving schisis cavity nasally. (e) One year later, after silicone oil was removed, the FTMH remained closed; schisis had resolved. Thinning and disorganization linger among layers previously affected by severe schisis.

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