Involutional macular thinning. A pre-macular hole condition.
We identified a group of 93 patients (102 eyes) with involutional macular thinning which is a condition that predisposes the affected eyes to developing idiopathic macular holes. The fovea in these patients shows specific architectural changes that can be identified on ophthalmoscopy. On follow-up (mean, 50 months), 26 eyes (27%) developed a macular hole compared to 0% in normal fellow eyes (P less than 0.00001). Patients with pigment epithelial window defects on fluorescein angiography (12 of 15 eyes or 80%), or with no posterior vitreous detachment (15 of 34 eyes or 44%) had the highest risk of developing macular holes. There were seven eyes with involutional macular thinning, pigment epithelial window defects on fluorescein angiography and no posterior vitreous detachment; six (86%) developed a macular hole. Macular degeneration, estrogen supplements, cystoid changes (with normal fluorescein angiography), and poor visual acuity did not increase risk. We present a theory for the pathogenesis of idiopathic macular holes.
D000328:Adult; D000368:Aged; D002829:Choroid / Q000098:blood supply; D003560:Cysts / Q000150:complications / Q000473:pathology; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008266:Macula Lutea / Q000473:pathology; D008268:Macular Degeneration / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D012164:Retinal Diseases / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D012167:Retinal Perforations / Q000209:etiology*; D012306:Risk; D014792:Visual Acuity; D014822:Vitreous Body / Q000502:physiology