Definition: Full thickness neurosensory defect at the fovea.
Demographics: Female around 60s.
Idiopathic / age related
Retinal vascular disease
Lightning / Electrocution
Stages (Gass classification)
Stage 1A: Impending hole
Stage 1B: Occult hole
Stage 2: < 400 microns
Stage 3: > 400 microns with incomplete PVD
Stage 4: > 400 microns with complete PVD
Signs & Symptoms:
Variable degree of central visual loss
Watzke-Allen test – positive
Fundus autofluorescence – prognostic value – hyperautofluorescnece disappears at macular hole that is close indicating RPE is recovering
Early Stage 2 MH and traumatic MH – observe for few weeks – may close spontaneously
Otherwise most will need MHS – PPV + ILM peel + gas tamponade +/- face down posturing.
Other additional surgical techniques – ILM peeling, use of autologous platelet, silicone oil use, ILM grafts.
Lamellar MH – observation for stable VA (8/10 patients remain stable).