Figure 1. Idiopathic Macular Hole
Î People with vitreous traction and no macular hole (stage 1-A or 1-B) should
be observed. They often remain stable or even improve. Currently, there is
no evidence that treatment improves the prognosis.
Î Most people with stage 2–4 macular holes have a poor prognosis without
treatment. With successful macular hole closure, however, visual prognosis
is usually good. Therefore, an ophthalmologist should discuss treatment
options that include the opportunity for macular hole closure and the
associated visual benefits.
Î Recent studies report that approximately 90% of recent macular holes that
are 400 µm or smaller are closed by means of vitrectomy surgery.
Î Macular holes that have been present for over 6 months have a lower closure
rate following vitrectomy, and such patients have less return of vision.
Î Macular holes are more common in females than males and usually
occur after age 55. There is a high rate of macular hole formation in the
fellow eye (10%–15%) in the 5-year period after a macular hole occurs
in the first eye.
Î Approximately 40% of holes 400 µm or smaller that are associated
with vitreous traction were closed following an intravitreal injection of
ocriplasmin.
Î To prevent visual field loss, prolonged air flow during the air-fluid exchange
should be minimized.
Î Cataract is a frequent complication of vitrectomy surgery to repair macular
holes. This risk should be discussed with patients preoperatively, and
postoperative monitoring is advised.
Courtesy of Mark W. Johnson, MD, and Peter K. Kaiser, MD.
© 2014 American Academy of Ophthalmolog y
Stage 2 macular hole with small opening
in inner layer eccentrically.
© 2014 American Academy of Ophthalmology
OCT of a stage 4 full-thickness
macular hole with operculum.
