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

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.

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

 
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