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Idiopathic Macular Hole

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Diagnosis Care Process Î The initial evaluation of a patient with symptoms and signs suggestive of macular hole includes all features of a comprehensive adult medical eye evaluation, with particular attention to those aspects relevant to macular hole. (II++, G, S) Î A complete history includes: duration and location of symptoms, ocular history, and medication use that may be related to macular cystoid edema. (III, G, D) Î Physical examination includes slit-lamp biomicroscopy of the macula and vitreoretinal interface, and the optic disc to rule out an optic pit or advanced cupping. (III, G, S) Î Physical examination also includes an indirect peripheral retinal examination and an Amsler grid test. (III, G, S) Î OCT offers detailed information about the anatomy and size of the macular hole and the presence of vitreous traction or an epiretinal membrane, all of which aid in the diagnosis, staging, and follow-up. (III, M, D) Î The initial evaluation should include a careful assessment of the fellow eye. (III, G, S) Î It is important to diagnose a macular hole in the fellow eye as soon as possible, and patients should be educated about warning signs such as metamorphosia or mild decreases in central visual acuity. (III, G, S) Î OCT may also help to identify at-risk eyes evident by vitreous traction at or near the center of the macula. (III, In, D) Table 3. Idiopathic Macular Hole (Initial Evaluation and Therapy) Initial Exam History (Key Elements) Initial Physical Exam (Key Elements) • Duration of symptoms • Visual acuity • Ocular history: glaucoma, retinal detachment or tear, other prior eye diseases or injuries, ocular surgery, or prolonged sun or eclipse gazing • Slit-lamp biomicroscopic examination of the macula, vitreoretinal interface, and optic disc to rule out an optic pit or advanced cupping • Medications that may be related to macular cystoid edema (e.g., systemic niacin, topical prostaglandin analogues) • Indirect peripheral retinal examination

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