Macular hole formation: new data provided by optical coherence tomography.
OBJECTIVE
To establish the sequence of events leading from vitreofoveal traction to full-thickness macular hole formation.


METHODS
Both eyes of 76 patients with a full-thickness macular hole in at least 1 eye were examined by biomicroscopy and optical coherence tomography.


RESULTS
Sixty-one fellow eyes had a normal macula. Optical coherence tomograms showed central detachment of the posterior hyaloid over the posterior pole in 19 cases (31%) and a perifoveal hyaloid detachment not detected on biomicroscopy in 26 cases (42%). In the 4 impending macular holes, optical coherence tomography disclosed various degrees of intrafoveal split or cyst, with adherence of the posterior hyaloid to the foveal center and convex perifoveal detachment. In the 14 stage 2 holes, eccentric opening of the roof of the hole was observed, and in the 24 stage 3 holes, the posterior hyaloid was detached from the entire posterior pole.


CONCLUSIONS
In fellow eyes of eyes with macular holes posterior hyaloid detachment begins around the macula, but the hyaloid remains adherent to the foveolar center, indicating the action of anteroposterior forces. This results in an intraretinal split evolving into a cystic space, and then to the disruption of the outer retinal layer and the opening of the foveal floor, thus constituting a full-thickness macular hole.
Gaudric
A
A
Department of Ophthalmology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université Paris 7, France. alain.gaudric@lrb.ap-hop-paris.fr
Haouchine
B
B
Massin
P
P
Paques
M
M
Blain
P
P
Erginay
A
A
D000368:Aged; D003941:Diagnostic Techniques, Ophthalmological; D005128:Eye Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D012167:Retinal Perforations / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D014054:Tomography / Q000379:methods*; D014822:Vitreous Body / Q000473:pathology