Vitreous & Retina

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Macular Diseases
OCT study and the corresponding color fundus photograph of a macular hole.

  • 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

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