Ultrastructure of the eggs of Culicoides circumscriptus, Culicoides gejgelensis, and Culicoides imicola (Diptera:Ceratopogonidae)

PURPOSE: To describe a newly identified clinical entity tentatively named white dot fovea. METHODS: We examined by scanning laser ophthalmoscopy 58 eyes of 30 patients (mean age, 64 years) who had white dots in the fovea (anatomically defined as the foveola) simulating macular hole. In addition, the retinal surfaces of 30 autopsy eyes from donors aged 70 years or older were observed by scanning electron microscopy. RESULTS: White dot fovea was bilateral in 28 of 30 patients (93%). It was characterized by the presence of numerous white dots on the foveal surface distributed either diffusely or along the foveal margin, forming a gray ring. There was no subjective symptom or visual disturbance. The condition was best seen by a scanning laser ophthalmoscope using argon blue laser as the light source. The white dots numbered from 100 to 300 per eye. Each dot was approximately 5 microns in diameter. Scanning electron microscopy showed foveal granules simulating the white dots in five of 30 autopsy eyes (17%). The granules had multiple protrusions with cilia-like structures resembling glial cells. This glia-like structure seemed to be a counterpart of clinically observed white dot fovea. CONCLUSION: White dot fovea is a new, frequent, and apparently innocuous clinical entity. It merits due attention in the differential diagnosis of macular holes.