Table 2. Stages and Characteristics of Macular Holes
Stage Characteristics
1-A
(impending )
• Loss of the foveal depression and a yellowish foveal spot (100–200 µm
in diameter)
• Localized shallow detachment of the perifoveal vitreous cortex with
persistent adherence to the foveola
• Vitreofoveolar traction may horizontally separate (split) the retina at the
fovea (pseudocyst) that corresponds to the yellow spot
• Epiretinal membranes are uncommon
• Visual acuity ranges from 20/25 to 20/80
• Surgical intervention is NOT recommended
1-B
(impending )
• Yellow ring 200–350 µm in diameter
• Posterior extension of the pseudocyst with disruption of the outer retinal
layer
• The retinal roof remains intact with persistent adherence of the posterior
hyaloid to the retina
• Epiretinal membranes are uncommon
• Visual acuity ranges from 20/25 to 20/80
• Surgical intervention is NOT recommended
2 • Small full-thickness (<400 µm in diameter) retinal defect
• Epiretinal membranes are uncommon
• Visual symptoms include metamorphopsia and decreased vision
• Visual acuity 20/25 to 20/80
3 • Full-thickness hole ≥400 µm in diameter
• The posterior hyaloid is separated from the macula but may remain
attached at the optic disc and be attached more peripherally
• An operculum or a flap is present on the posterior hyaloid over the hole
and is visible clinically or by optical coherence tomography (OCT)
• A cuff of subretinal fluid may be detected along with intraretinal edema
and cysts
• Drusen-like deposits
a
may occasionally be seen in the base of the hole
• A rim of retinal pigment epithelium hyper/hypopigmentation is often
present at the junction between edematous or detached retina and normal-
appearing attached retina in long-standing cases
• Epiretinal membranes may be present
• Visual acuity usually ranges from 20/100 to 20/400
4 • A full-thickness hole with a diameter usually larger than stage 3 (>400 µm)
• A complete posterior vitreous detachment with a Weiss ring
• A cuff of subretinal fluid, intraretinal edema, and cystoid changes are
usually present
• Drusen-like deposits
a
may occasionally be seen in the base of the hole
• Epiretinal membranes are more frequent
• Visual acuity is more profoundly decreased from 20/100 to 20/400
a
Drusen-like or yellow deposits may represent macrophages at the level of the retinal pigment epithelium,
suggesting chronicity of disease.
