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
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