Etiology
Î Most investigators believe that macular holes are caused by pathologic
vitreoretinal traction at the fovea. Uncontrolled series also suggest that
trauma may be responsible for a minority of macular hole cases.
Î The formation of a macular hole typically evolves over a period of weeks to
months, although some macular holes may develop more rapidly. In either
case, macular holes are frequently detected when the patient's symptoms
change relatively abruptly.
Î Typically, the patient will experience metamorphopsia and decreased visual
acuity.
Î A lamellar macular hole is a partial-thickness defect in the neurosensory
retina, whereas a macular pseudohole is an epiretinal membrane with a
circular or oval configuration that gives the false clinical appearance of a
full-thickness macular hole (FTMH).
Î In the United States, a population-based retrospective study of the largely
Caucasian residents (>90%) of Olmsted County, Minnesota, estimated the
age- and sex-adjusted incidence of macular holes to be 7.8 people and 8.7
eyes per 100,000 people per year.
Î More than 50% of holes were found in individuals 65–74 years of age and
72% in women.
Î The 5-year risk of a patient with a FTMH of developing a FTMH in the fellow
eye is approximately 10%–15%, especially when the vitreous remains
attached or a lower risk when the vitreous appears detached.
