limiting membrane is extremely fragile and it can be easilybroken. Therefore, one has to try to find and grasp the edgeof the internal limiting membrane several times. Thoseattempts may cause punctate lesions in the macular area.We also agree that indocyanine green staining enhancesthe visualization. After indocyanine green staining, it ismuch easier to see and grasp the internal limiting mem-brane. Indocyanine green staining also makes the internallimiting membrane much stronger, like a parchment.However, the potential toxicity related to the use ofindocyanine green staining has been reported and shouldbe kept in mind.1–3 Therefore, our preferred instrument topeel the internal limiting membrane is still end-grippingforceps. We thank Drs. Lai and Kwok for their comments.

MURAT KARACORLU, MD, MSC

SERRA KARACORLU, MD

HAKAN OZDEMIR, MD

Istanbul, Turkey

REFERENCES

1. Enaida H, Sakamoto T, Hisatomi T, Goto Y, Ishibashi T.Morphological and functional damage of the retina caused byintravitreous indocyanine green in rat eyes. Graefes Arch ClinExp Ophthalmol 2002;240:209–213.

2. Gandorfer A, Haritoglou C, Gandorfer A, Kampik A. Retinaldamage from indocyanine green in experimental macularsurgery. Invest Ophthalmol Vis Sci 2003;44:316–323.

3. Haritoglou C, Gandorfer A, Gass CA, Schaumberger M,Ulbig MW, Kampik A. The effect of indocyanine-green onfunctional outcome of macular pucker surgery. Am J Ophthal-mol 2003;135:328–337.

Foveal Hypoplasia DemonstratedIn Vivo With Optical CoherenceTomography

EDITOR:

MCGUIRE AND ASSOCIATES DEMONSTRATED FOVEAL

hypoplasia by optical coherence tomography (Am J Oph-thalmol 2003;135:112–114). Their patient had a reducedvisual acuity and jerk nystagmus that neutralized in theprimary position so that they were able to perform opticalcoherence tomography.

We also studied foveal hypoplasia demonstrated withoptical coherence tomography in a patient with oculocu-taneous albinism.1 Similar to their case, our patient had ahypopigmented fundus with a poorly defined fovea and ahorizontal pendular jerk nystagmus. Bilateral recession ofthe horizontal muscles was performed, decreasing theamplitude of the nystagmus and significantly improvingnear vision. The patient was able to find a centralized nullpoint, allowing for improved reading abilities and also forfurther clinical testing involving optical cohorence tomog-raphy of the macular area. Usually, optical coherence

tomography scanning takes approximately 2 seconds;therefore, we performed multiple cross-sectional scans notto lose the fovea by possible microsaccades. Additionally,we measured in each horizontal and vertical scan a fovealthickness greater than 300 �m. Moreover, Recchia andassociates2 recently demonstrated foveal hypoplasia bythree-dimensional optical coherence tomography. Theadvantage of this technique is that not only the cross-sectional structure of the retina, but also the three-dimensional thickness of the fovea, can be determined inpatients with foveal hypoplasia.2

We agree with McGuire and associates that opticalcoherence tomography is helpful in providing the diagnosisof foveal hypoplasia.

CARSTEN H. MEYER, MD

Marburg, GermanyDEBORAH J. LAPOLICE, MS

SHARON F. FREEDMAN, MD

Durham, North Carolina

REFERENCES

1. Meyer CH, Lapolice DJ, Freedman SF. Foveal hypoplasia inoculocutaneous albinism demonstrated by optical coherencetomography. Am J Ophthalmol 2002;133:409–410.

2. Recchia FM, Carvalho-Recchia CA, Trese MT. Optical co-herence tomography in the diagnosis of foveal hypoplasia.Arch Ophthalmol 2002;120:1587–1588.

AUTHOR REPLY

WE CONGRATULATE DR. MEYER AND COWORKERS FOR

their description of the appearance of foveal hypoplasia byoptical coherence tomography in oculocutaneous albi-nism.1 In the last few years, multiple papers have beenpublished describing optical coherence tomography as ameans to help us visualize the retina and understanddiseases affecting the retina. At the Midwest OcularAngiography Conference at Lake Louise, Canada, inAugust 2001, we presented the application of opticalcoherence tomography in our case of foveal hypoplasia,indicated by fluorescein angiography, not to have ocularalbinism. Since then, we and two other centers inde-pendently confirmed with optical coherence tomogra-phy in vivo the anatomic alterations from fovealhypoplasia previously observed by histopathologic ex-amination.2,3

We appreciate the establishment by Dr. Meyer andcoworkers of the value of optical coherence tomography toassist in the diagnosis in these patients.

DESMOND E. MCGUIRE, MD

MICHAEL H. GOLDBAUM, MD

La Jolla, California

CORRESPONDENCEVOL. 136, NO. 2 397