10.2

Full-Thickness Macular Hole

Introduction:

A macular hole is a full-thickness defect in the neurosensory retina occurring at the macular center, usually associated with a central scotoma and decreased vision. Macular holes can be primary (formerly referred to as ‘idiopathic’), resulting from vitreomacular traction (VMT) in the course of anomalous posterior vitreous detachment. Primary macular holes are more common in women, most often seen in the sixth or seventh decade of life. Primary macular holes may be bilateral in 10–20% of cases. Secondary macular holes are due to forces other than VMT. They can be traumatic, associated with posterior staphylomas in severe myopia, epiretinal membrane, cystoid macular edema, or rarely associated with solar retinopathy.

Clinical Features:

Classic symptoms are acute unilateral decreased vision and occasional metamorphopsia. An impending macular hole may be seen as a loss of the normal fovelar depression with a yellow spot or ring in the center of the macula. A full-thickness macular hole (FTMH) is seen as a well demarcated, round red spot in the center of the macula surrounded by a grey halo that represents a cuff of subretinal fluid around the hole (Fig. 10.2.1) An operculum may be seen above the hole. Yellowish deposits may be seen within the hole.

Figure 10.2.1 Fundus photograph of a full-thickness macular hole. The picture to the left shows an acute hole, whereas the one on the right shows a chronic hole with retinal pigment epithelium changes at the margin.

Macular holes were classified according to their clinical findings. However, with OCT data available, this classification system is now in flux. This is described in some detail below.

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