Hole in the Fovea!

⁣⁣⁣⁣⁣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⁣⁣⁣⁣⁣⁣

● Cystoid macular edema⁣ etc⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣

𝘊𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘧𝘦𝘢𝘵𝘶𝘳𝘦𝘴:⁣⁣⁣⁣⁣⁣

• Loss of central visual acuity, metamorphosia, micropsia⁣⁣⁣⁣⁣⁣

𝘗𝘢𝘵𝘩𝘰𝘨𝘦𝘯𝘦𝘴𝘪𝘴:⁣⁣⁣⁣⁣⁣

• Tangential and anteroposterior traction of the posterior hyaloid on the parafovea⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣

𝘎𝘢𝘴𝘴 𝘚𝘵𝘢𝘨𝘪𝘯𝘨: ⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣

• 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 𝘢𝘯𝘥 𝘐𝘯𝘷𝘦𝘴𝘵𝘪𝘨𝘢𝘵𝘪𝘰𝘯𝘴:⁣⁣⁣⁣⁣⁣

● 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⁣⁣⁣⁣⁣⁣

● 𝘖𝘱𝘵𝘪𝘤𝘢𝘭 𝘊𝘰𝘩𝘦𝘳𝘦𝘯𝘤𝘦 𝘛𝘰𝘮𝘰𝘨𝘳𝘢𝘱𝘩𝘺⁣⁣⁣⁣⁣⁣ For diagnosis and staging, prognosis⁣⁣⁣⁣⁣⁣

● FFA⁣⁣⁣⁣ - Early hyperfluorescence (window defect)⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣

𝘔𝘢𝘯𝘢𝘨𝘦𝘮𝘦𝘯𝘵:⁣⁣⁣⁣⁣⁣

● Observation (50% of stage 1 holes resolve spontaneously)⁣⁣⁣⁣⁣⁣

● Pharmacological vitreolysis with ocriplasmin⁣⁣⁣⁣⁣⁣

● Surgery – PPV with ILM peeling and gas⁣⁣⁣ tamponade⁣⁣⁣⁣

⁣⁣

⁣⁣⁣⁣⁣⁣ www.ophthalmobytes.com⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣

Image from Rajan Eye Care Hospital

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