Fundus photograph of a macular hole with drusen-like yellow deposits and a cuff of subretinal fluid and the corresponding OCT study.

Presents as a full thickness central macular defect or tear. Mostly occurs in elderly women. Mechanism: Idiopathic, spontaneous focal contraction or shrinkage of the prefoveal vitreous. Can be secondary to posterior vitreous separation or severe ocular trauma. Clinical features: Symptoms: Various degrees of decreased visual acuity Metamorphopsia Signs: depends on the staging of the hole according to Gass's classification. Stage 1: "Impending" macular hole Localized foveal detachment, loss of foveal depression associated with retraction of the retinal receptor (occult hole) and the presence of yellowish macular spot or ring Fine radiating retinal striae may be observed Visual acuity usually better than 20/50 Stage 2: Small hole begins to develop (<400 µ) A 360-degree can-opener type hole may develop The hole may be covered by an overlying pseudo-operculum (pre-foveal opacity) which usually larger than the hole Visual acuity is in the 20/50 - 20/80 range Stage 3: Larger macular hole (>400 µ) Pseudo-operculum may still present Often has a cuff of subretinal fluid Drusen-like deposits may be seen at the base of the hole Mean visual acuity : 20/200 Stage 4: Complete separation of the vitreous from the entire macular surface and optic disc Fluorescein angiography in patients starting from stage 2 typically demonstrates early hyperfluorescence in the area of the hole Optical coherence tomography has proven to be extremely helpful in the diagnosis of macular hole Management: Pars plana vitrectomy Intravitreal gas tamponade Epiretinal membrane peeling

Copyright © 2003 Digital Reference of Ophthalmology. All rights reserved. All material published on this website is the property of Digital Reference of Ophthalmology and cannot be duplicated without permission.