Macular Hole

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Definition

  • distinguish between full-thickness macular hole and lamellar macular hole (partial-thickness)

Symptoms

  • Metamorphopsias, central scotoma, reduced visual acuity

Examination

  • OCT
  • Fundoscopy, (Watzke-Allen-Sign)

Classification

  • The International Vitreomacular Traction Study Group (2013): OCT-based classification system
    • Vitreomacular Adhesion (VMA)
    • Vitreomacular Traction (VMT)
    • Full-thickness macular hole
      • Size: small (<250 µm), medium (250-400 µm), large (>400 µm)
  • Gass (1988/1995): biomicroscopic, stages 0-4
    • Stage 1a: impending macular hole
    • Stage 1b: occult macular hole
    • Stage 2: small full-thickness hole (<400um)
    • Stage 3: large full-thickness hole (>400um) with incomplete posterior vitreous detachment
    • Stage 4: large full-thickness hole (>400um) with complete posterior vitreous detachment

Therapy

  • depending on stage and onset of macular hole
  • usually no surgery in partial-thickness macular holes, VMA and VMT
  • Indication for surgery in stages 3 + 4 (Gass), consider surgery in stage 2 (spontaneous closure possible)
  • Pars plana vitrectomy with ILM-peeling + tamponade
  • postoperative face-down positioning (duration controversial)

Sources

  • EyeWiki Macular Hole
  • The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole. Ophthalmology. 2013.
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)