title: Movement of the inner retina complex during the development of primary full-thickness macular holes: implications for hypotheses of pathogenesis.
abstract: BACKGROUND
  The inner retinal complex is a well-defined layer in spectral-domain OCT scans of the retina. The central edge of this layer at the fovea provides anatomical landmarks that can be observed in serial OCT scans of developing full-thickness macular holes (FTMH). Measurement of the movement of these points may clarify the mechanism of FTMH formation.
  
  
  METHODS
  This is a retrospective study of primary FTMH that had a sequence of two OCT scans showing progression of the hole. Measurements were made of the dimensions of the hole, including measurements using the central edge of the inner retinal complex (CEIRC) as markers. The inner retinal separation (distance between the CEIRC across the centre of the fovea) and the Height-IRS (average height of CEIRC above the retinal pigment epithelium) were measured.
  
  
  RESULTS
  Eighteen cases were identified in 17 patients. The average increase in the base diameter (368 microns) and the average increase in minimum linear dimension (187 microns) were much larger than the average increase in the inner retinal separation (73 microns). The average increase in Height-IRS was 103 microns.
  
  
  CONCLUSIONS
  The tangential separation of the outer retina to produce the macular hole is much larger than the tangential separation of the inner retinal layers. A model based on the histology of the Muller cells at the fovea is proposed to explain the findings of this study.
authors: Department of Ophthalmology, St James' Hospital, Beckett St, Leeds, LS9 7LS, UK. hong.woon@nhs.net.
authors: Wai H
authors: WH
authors: Woon
authors: University of Leeds, Leeds, UK.
authors: Denis
authors: D
authors: Greig
authors: University of Leeds, Leeds, UK.
authors: Mike D
authors: MD
authors: Savage
authors: University of Leeds, Leeds, UK.
authors: Mark C T
authors: MC
authors: Wilson
authors: University of Bradford, Bradford, UK.
authors: Colin A
authors: CA
authors: Grant
authors: Department of Ophthalmology, St James' Hospital, Beckett St, Leeds, LS9 7LS, UK.
authors: Bataung
authors: B
authors: Mokete
authors: Department of Ophthalmology, St James' Hospital, Beckett St, Leeds, LS9 7LS, UK.
authors: Fiona
authors: F
authors: Bishop
mesh_terms: D000368:Aged; D002465:Cell Movement; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012164:Retinal Diseases / Q000473:pathology; D055351:Retinal Neurons / Q000473:pathology*; D012167:Retinal Perforations / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies; D000267:Tissue Adhesions; D041623:Tomography, Optical Coherence; D020255:Vitreous Detachment / Q000473:pathology
keywords: Bistable; Full-thickness macular hole; Muller cells; Pathogenesis; Vitreomacular traction