Full-thickness Macular Hole
Round retinal break involving all the layers of the retina at the fovea
More common in females
CAUSES:
Idiopathic
Pathological Myopia
Blunt ocular trauma
Ocular inflammation
Laser induced
Cystoid macular edema
Solar retinopathy
CLINICAL FEATURES:
Loss of central visual acuity (varies depending on the stage of the hole)
Metamorphopsia, micropsia
PATHOGENESIS:
Tangential and anteroposterior traction of the posterior hyaloid on the parafovea
GASS CLASSIFICATION:
Stage 0 (Vitreomacular adhesion) : OCT finding of oblique foveal vitreoretinal traction
before the appearance of clinical changes
Stage 1a : Impending macular hole (Vitreomacular Traction) : Yellow spot
Stage 1b : Occult macular hole (VMT) : Yellow ring
Stage 2 : Small FTMH < 400 microns in diameter. Persistent vitreofoveolar adhesion.
Stage 3 : Full thickness hole > 400 microns with a red base in which yellow white dots are seen. Surrounding grey cuff of subretinal fluid seen. Overlying retinal operculum.
Stage 4 : Full size macular hole with complete PVD. The posterior vitreous is completely detached, often suggested by the presence of a Weiss ring.
DIAGNOSIS:
Clinical examination through slit lamp biomicroscopy/ indirect ophthalmoscopy.
Amsler Grid
Watzke- Allen Test: Narrow vertical slit beam over the fovea with a 90/78D - Break in the bar of light indicates presence of FTMH
Laser aiming beam Test: 50 micron laser beam within lesion- patients with FTMH cannot detect it within the lesion but can detect it when placed in the surroundings
OCT Macula: For diagnosis and staging, prognosis
Small hole <250 microns
Medium hole 250-400 microns
Large hole >400 microns, with likely vitreous separation from macula
FFA : Early hyperfluorescence (window defect)
MANAGEMENT:
Observation (50% of stage 1 holes resolve spontaneously)
Pharmacological vitreolysis with ocriplasmin
Surgery – Pars plana Vitrectomy with ILM peeling, Induction of total PVD, Gas tamponade
Image from Rajan Eye Care Hospital
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