Macular Hole

Definition: Full thickness neurosensory defect at the fovea.

Demographics: Female around 60s.

Causes:

• Idiopathic / age related

• Trauma

• Chronic CMO

• Laser treatment

• Retinal vascular disease

• RD

• 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

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Signs & Symptoms:

• Variable degree of central visual loss

• Metamorphosia

• Watzke-Allen test – positive

Investigations:

• OCT macula

• Fundus autofluorescence – prognostic value – hyperautofluorescnece disappears at macular hole that is close indicating RPE is recovering

Management:

• 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.

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Lamellar MH – observation for stable VA (8/10 patients remain stable).