Idiopathic Macular Hole

Abstract

Idiopathic macular hole is a disease that arises from adhesion in the vitreomacular interface and can theoretically be treated by vitrectomy surgery. Surgical techniques include removal of the vitreous with or without simultaneous peeling of the internal limiting membrane (ILM), fluid-air exchange, and gas tamponade. Since the advent of microincision vitrectomy surgery, macular hole surgery has been performed with minimal invasiveness, and significant visual improvement is a common outcome. This chapter describes the pathology of this disease, including presurgical evaluation using optical coherence tomography (OCT), and then shows the fundamental techniques required for the surgery. Also important is the understanding of the postsurgical 'healing' process of the disease, which may confirm the fact that the subjective improvement is closely related to the retinal imaging obtained by OCT. More recent advances are the inverted ILM peeling technique for larger macular holes and 27-gauge vitrectomy that can potentially minimize the surgical invasiveness mainly by smaller wound construction and the reduced volume of irrigation during surgery.

Pars Plana Vitrectomy with Internal Limiting Membrane Peeling in Traumatic Macular Hole: 14% Perfluoropropane (C3F8) versus Silicone Oil Tamponade

“…This might be due to the nature of the cases, like silicone oil, being used for larger traumatic macular holes with consequently more photoreceptor and RPE damage. Anatomical closure rates in this study were favorably compared with previous reports of traumatic macular hole 20 as well as myopic [ 20 ] or idiopathic hole [ 21 ]. This could be attributed to younger patient age, relatively earlier diagnosis, and the fact that overall natural closure rate of traumatic macular hole is higher than that of myopic or idiopathic hole [ 22 – 24 ].…”

Disease of the Year: Differential Diagnosis of Uveitic Macular Edema

“…In addition, there have been histopathological reports that suggest cystoid changes that occur in the retinal tissues leading to development of a full-thickness hole. [63][64][65] Macular holes typically present with a well-defined rounded excavation of retinal tissue in the central macula. However, these holes can have associated retinal thickening, intraretinal fluid, and macular edema.…”

“…Occasionally, there may be associated epiretinal membranes resulting in fine crinkling. 64,66,67 Therefore, in the evaluation of a macular hole, it is imperative to analyze the OCT scans carefully, especially in situations where the size of the hole is small. Small macular holes may be missed if all the OCT scans are not evaluated (Figure 3).…”

Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes

“…В последние десятилетия патология макулярной области сетчатки устойчиво занимает ведущие позиции в структуре слабовидения взрослого населения развитых стран. Одним из таких нарушений, приводящих к необратимому ухудшению зрения, являются сенильные, или идиопатические, макулярные отверстия (МО) [1][2][3][4][5].…”

“…Идиопатические МО преимущественно встречаются у лиц старше 65 лет. Их распространенность достигает 0,1-0,8% среди лиц старше 40 лет, примерно 2 / 3 пациентов составляют женщины, состояние является односторонним в 80% случаев [2,4].…”