Full-thickness macular hole (FTMH) is a full-thickness defect resulting in absence of all retinal layers from the internal limiting membrane to retinal pigment epithelium at the fovea (Figure 31.1).

FTMHs have a prevalence rate of 0.02 % to 0.33% with 5% to 20% nonsimultaneous bilateral involvement.¹

Symptoms of FTMH include metamorphopsia, varying degrees of visual loss, and central scotoma.

FTMHs are classified as either primary and secondary.

The majority of FTMHs are primary, resulting from vitreomacular traction (VMT). Risk factors associated with primary FTMH are female gender and older age (Figure 31.2).

Secondary FTMH causes include trauma, ocular inflammation, and high-degree myopia (Figure 31.3).

Optical coherence tomography (OCT) has enabled aperture size-based classification of FTMH: small (≤250 mm), medium (>250 ≤ 400 mm), or large (>400 mm).²

OCT is the current gold standard for the diagnosis, staging, and monitoring of FTMH.

The basic morphologic features of FTMH include hourglass-shaped loss of all retinal layers in the macula (Figures 31.2 and 31.4).

Retinal edges are usually rounded and may be thickened due to cystic intraretinal changes, which present on OCT as focal hyporeflective circular structures within the retinal tissue. A small amount of subretinal fluid, which presents as a hyporeflective space between the retina and the RPE, is often present at the hole edge (Figure 31.2).