Spontaneous closure of macular hole after posterior vitreous detachment

Macular holes can be treated with surgically-induced vitreous detachment and gas tamponade. The authors report a case of a macular hole that closed spontaneously after the development of posterior vitreous detachment (PVD). Optical coherence tomography (OCT) revealed a small full-thickness macular hole with perifoveal cystic changes in a 25-year-old female with a central scotoma at her initial visit. There was no evidence of PVD. Five months later, PVD was observed and the macular hole disappeared. OCT performed three months later showed macular hole closure and resolution of the perifoveal cystic changes. The physiologic pit was restored in the fovea. OCT is useful to detect and monitor the morphologic changes of a macular hole.     

Full-thickness macular hole formation associated with pigment epithelial detachment: link or coincidence?

To report two cases of full-thickness macular hole (FTMH) formation associated with pigment epithelial detachment (PED). Two patients presenting with visual loss and metamorphopsia were evaluated with fundal fluorescein angiography (FFA) and optical coherence tomography (OCT). Case 1: Fundus examination and FFA revealed a small subfoveal PED. Subsequent serial OCT elucidated the progressive formation of a FTMH. Case 2: Fundus examination and FFA revealed a small PED and changes suggestive of central serous retinopathy (CSR). Subsequent OCT illustrated a FTMH with an underlying small PED at the base of the hole. It is possible that, in at least some cases of macular hole formation, there may be a causative link with PED. To my knowledge, this is the first report of full-thickness macular hole formation associated with pigment epithelial detachment.     

特发性黄斑裂孔患者玻璃体后脱离的相干光断层成像特征

目的 观察特发性黄斑裂孔患者玻璃体后脱离的相干光断层成像（optical coherence tomography,OCT)特征,探讨裂孔的发生与玻璃体后脱离间的关系。方法 对临床确诊的特发性黄斑裂孔患者193例（223只眼）进行OCT检查,分析其玻璃体后脱离的发生及发展。结果 按Gass分期标准,I-Ⅳ期裂孔分别为21,74,97有31只眼,在Ⅰ,Ⅱ,Ⅲ期裂孔眼中,OCT图像显示玻璃体与视网膜分离者分别有15（71．4％）,38（51．4％）及46只眼（47．4％）。其表现形式有3种：（1）黄斑中心凹周围视网膜与玻璃体发生分离,但中心凹部相连,此处视网膜神经上皮层被牵起,层间出现囊腔;（2）玻璃体附着于未完全游离的视网膜裂孔盖处,使盖膜牵引上翘;（3）玻璃体完全与后极部视网膜分离,表现可见与其平行的玻璃体后介膜。这3种表现形式分别于Ⅰ,Ⅱ,Ⅲ期裂孔。在随诊的部分患眼中,OCT图像显示出I期进展至Ⅲ期裂孔的过程,并见玻璃体后脱离的裂孔自行愈合现象。在组合的OCT图像中,显示黄斑中心凹部与视乳头和颞侧视网膜之间脱离的玻璃体事 于现凹隆圆顶盖样图形。结论 OCT检测结果证实玻璃体与黄斑中心凹发生分离的过程与黄斑裂孔进展的过程相一致,提示黄斑裂孔的形成及发展与玻璃体后脱离的发生密切相关。     

光相干断层扫描在观察特发性黄斑裂孔 病程进展中的应用

目的应用光相干断层扫描（OCT）对临床诊断为Ⅰ～Ⅳ期特发性黄斑裂孔患眼进行随诊观察，了解其裂孔进展过程及与玻璃体后分离的相互关系。方法按Gass的临床分期标准，结合OCT图像特征，诊断特发性黄斑裂孔Ⅰ～Ⅳ期未行手术治疗的72只眼，进行OCT随诊检查。结果Ⅰ～Ⅳ期裂孔分别为23、19、11、19只眼，随诊时间最长43个月（平均13.4个月），每只眼OCT检查次数2～10次（平均4.7次），在随诊期间，Ⅰ期裂孔23只眼，9只眼(39.1%)进展为Ⅱ～Ⅲ期裂孔,2只眼玻璃体后脱离（PVD）后中心凹曲线恢复正常；Ⅱ期裂孔19只眼，13只眼(68.4%)进展为Ⅲ～Ⅳ期裂孔,有1只眼PVD后裂孔自行愈合；Ⅲ期裂孔11只眼，5只眼(45.5%)进展为Ⅳ期裂孔，1只眼12个月后裂孔部分自行愈合。OCT图像显示，玻璃体从黄斑中心凹周围开始与视网膜分离，直至完全后脱离的过程与黄斑裂孔进展过程一致。在随诊期间，15只眼因病程进展接受手术治疗。结论黄斑裂孔形成和发展与玻璃体后脱离的发生密切相关。OCT可直观显示黄斑裂孔的进展变化，对提供IMH的分期诊断和手术指征有较大帮助。(中华眼底病杂志,2005,21:79-82)     

Tomographic features and surgical outcomes of vitreomacular traction syndrome

PURPOSE: To study the relation between preoperative macular changes and surgical outcomes in vitreomacular traction syndrome. DESIGN: Prospective study. METHODS: We prospectively examined 14 eyes of 13 patients (aged 48 to 82 years; mean 66.1) with vitreomacular traction syndrome using optical coherence tomography (OCT) before and after vitreous surgery. RESULTS: OCT demonstrated two types of partial posterior vitreous detachment: incomplete V-shaped detachment in 10 eyes (group 1) and partial detachment temporal to the fovea but attached nasally in 4 eyes (group 2). Preoperative OCT showed foveal retinal detachment in all eyes in group 1; the detached retina was intact in 2 eyes and edematous with (6 eyes) or without (2 eyes) cystic changes. After surgery, these 10 eyes had a normal foveal configuration accompanied by visual improvement. In group 2, 3 of the 4 eyes had prominent cystoid macular edema (CME) without foveal retinal detachment before surgery. After surgery, 2 eyes developed a full-thickness macular hole, 1 had persistent CME, and 1 developed macular atrophy. The visual acuity decreased in 2 eyes and remained the same in 2 eyes. CONCLUSIONS: Two types of vitreous traction develop in vitreomacular traction syndrome: an incomplete V-shaped posterior vitreous detachment that leads to foveal retinal detachment, the surgical outcome of which is favorable, and partial posterior vitreous detachment temporal to the fovea in which prominent CME developed, which may result in a macular hole or macular atrophy postoperatively.     

Bartonella henselae infection presenting as a unilateral acute maculopathy

BACKGROUND: The purpose of this article is to report an unusual ocular manifestation of cat scratch disease (CSD) presenting as a unilateral acute maculopathy (UAM). We describe and review the clinical, laboratory, fluorescein angiography (FA), indocyanine green angiography (ICG) and optical coherence tomography (OCT) records of a patient with CSD. HISTORY AND SIGNS: A 30-year-old Chinese woman presented with a painless progressive visual loss affecting her left eye. Fundus examination of the left eye disclosed rare vitreous cells and a deep-creamy choroidal macular lesion with satellite foci of choroiditis. THERAPY AND OUTCOME: FA revealed an early hypofluorescence of the lesion, becoming progressively hyperfluorescent with a leakage on the late phase. The ICG disclosed an early hypofluorescence of the macular lesion with a mild staining of its periphery on the late frames. Hypofluorescent satellite lesions were visible both on the early and late frames. The OCT disclosed a serous retinal detachment at the level of the whitish lesion. Serologies for Bartonella henselae (BH) became positive (IgG 1: 512, IgM < 1:20) confirming an active or recent infection. CONCLUSIONS: Ocular manifestations of CSD can appear as a UAM with satellite lesions. CSD should be ruled out in patients manifesting such clinical features.     

Optical coherence tomographic observations before and after macular hole formation secondary to laser injury

PURPOSE: To describe the ophthalmoscopic and optical coherence tomographically determined retinovitreous interface before and after the development of a macular hole secondary to an accidental laser injury. DESIGN: Observational case report. METHODS: Ophthalmoscopic and optical coherence tomography (OCT) findings in a 53-year-old man were evaluated before and after the macular hole formation secondary to a laser injury. Visual function was followed for 9 months after surgery. RESULTS: A 53-year-old man sustained injury to his right eye by a Ti: Sapphire laser. On the following day, his corrected visual acuity was 0.3, and a small pigment epithelial atrophy was present in the right foveal area. No macular hole was detected by OCT and the retinovitreal interface was normal. Fifty-three days later, a full-thickness macular hole appeared, and no posterior vitreous detachment was detected by OCT. The hole was closed by surgery with final best-corrected visual acuity of 0.7. CONCLUSIONS: Macular holes can develop without visible traction on the retina and can occur long after retinal injury.     

Spontaneous resolution of a full thickness idiopathic macular hole: fundus autofluorescence and OCT imaging

Background To report on the spontaneous closure of a full thickness juxtafoveolar idiopathic macular hole (IMH) monitored with fundus autofluorescence (AF) as well as optical coherence tomography (OCT) imaging. Methods Observational case report. Fundus Autofluorescence with a confocal SLO (HRA, Heidelberg Engineering,Germany) and OCT imaging were used to monitor the spontaneous evolution of a stage II IMH. Results A 70 year-old woman with unremarkable ocular history received a diagnosis of idiopathic macular hole in the left eye. Bright autofluorescence corresponding to the IMH was documented with the confocal SLO and OCT imaging could confirm the presence of an hour glass shaped full thickness juxtafoveolar IMH. Biomicroscopy revealed no posterior vitreous detachment (PVD). Few months later clinical examination demonstrated the presence of typical symptoms and signs of PVD (miodesopsias and Weiss ring). The bright autofluorescence corresponding to the IMH disappeared and OCT imaging documented a normal fovea in morphology and thickness. Conclusions Spontaneous closure of full thickness juxtafoveolar IMH can occur and may be properly monitored with fundus AF as well as OCT imaging.     

Optical coherence tomography study of vitreoretinal interface in full thickness macular hole associated with optic disk pit maculopathy

PURPOSE: To evaluate by optical coherence tomography (OCT) the vitreous involvement in full thickness macular hole associated with optic disk pit maculopathy. METHODS: Two patients with optic disk pit maculopathy and full thickness macular hole underwent OCT for evaluation of vitreous involvement in the pathogenesis of the disease. Fluorescein angiography and fundus photographs were also performed. RESULTS: OCT documented the presence of vitreous traction at the edge of the full thickness macular hole in the first case and on the elevated macula in the second case. Partial posterior vitreous detachment was also noticed. CONCLUSIONS: Previously unreported OCT findings such as vitreous traction at the edge of the macular hole and on the elevated macula were found. OCT provided evidence for vitreous participation in full thickness macular hole associated with optic disk pit maculopathy. OCT was also able to show that the full thickness macular hole and optic disk pit maculopathy were probably caused by similar vitreous tractional forces.     

Optical coherence tomographic documentation of the formation of a traumatic macular hole

PURPOSE: To assess how optical coherent tomography 3 (OCT3) images help explain the mechanism of traumatic macular hole formation. DESIGN: Observational case report. METHOD: A patient presented with an altered foveal depression after a unilateral blunt eye trauma. After four days, the injury developed into an impending macular hole. Follow-up was done by ophthalmic examination, fundus photography, and OCT3. RESULTS: Fundus examination showed a macular edema at first presentation, with a dot hemorrhage next to the fovea and a perifoveal little yellow ring. Minimal macular edema and a small foveal depression were seen on OCT3. After four days, an impending hole had formed. The foveal cyst closed after one month, but subretinal fluid persisted for months. After six months, full recovery was observed. CONCLUSIONS: Subclinical foveal changes occurred directly after the trauma, preceding macular hole formation. OCT3 allows detection of small lesions, which helps explain the pathogenesis of traumatic macular hole formation.     

Vitreous findings in optic disc pit maculopathy based on optical coherence tomography

Background To assess vitreous findings in optic disc pit maculopathy using Optical Coherence Tomography (OCT). Methods Thirty-eight eyes of 38 patients (14–51 years of age) with macular detachment associated with optic disc pit maculopathy were included in the study. The patients were divided into two groups. In group 1, 16 eyes were studied by OCT at presentation and after surgical treatment. In group 2, 22 eyes were examined by OCT only after treatment. In both groups thorough vitreous examination was performed over the macula and the optic disc. All patients were operated by the macular buckling procedure. Results Vitreous abnormalities were found in 28 out of 38 eyes (74%) of both groups. In group 1, 10 of the 16 eyes had vitreous traction on the macula at presentation. The traction started from the optic disc and terminated to the macula. The posterior hyaloid that exerted the traction between the points of adhesion at the optic disc and the macula had a course parallel to the retinal surface in 9 of the 10 cases. Postoperatively, vitreous traction on the macula was not found. Of the remaining 6 eyes 4 had complete or partial posterior vitreous detachment. In group 2, 8 eyes had vitreous strands over the optic disc and 5 eyes posterior vitreous detachment. In the remaining 9 cases no vitreous involvement was noticed. Conclusions OCT was able to detect vitreous abnormalities such as vitreomacular traction, vitreous strands over the optic disc and complete or partial posterior vitreous detachment associated with optic disc pit maculopathy. Our observations support the view that the abnormal vitreous over the macula and optic disc is likely to play a role in the development of macular elevation in cases with optic disc pit. Prospective OCT studies could further assist to better understand the role of vitreous in this disease.     

Macular hole development in fellow eyes of patients with unilateral macular hole

PURPOSE: To determine the incidence of developing an idiopathic full-thickness macular hole in fellow eyes that have vitreofoveal attachments and perifoveal vitreous detachment in patients with unilateral idiopathic macular hole. DESIGN: Retrospective cross-sectional observational study. METHODS: The fellow eyes of 201 patients with full-thickness macular holes were examined by optical coherence tomography (OCT). A subset of 58 fellow eyes with vitreofoveal attachments and perifoveal vitreous detachment was observed during follow-up, and the changes in the vitreofoveal attachment within 24 months from the initial OCT examination were investigated. RESULTS: In the 58 eyes, the vitreofoveal relationship changed in 27 eyes. Among the 27 eyes, three eyes developed a full-thickness macular hole, and the other 24 eyes developed a posterior vitreous detachment only over the fovea or a complete posterior vitreous detachment without macular hole formation. The vitreofoveal relationship did not change in 31 eyes during the 24-month period. CONCLUSION: From an analysis of the changes in the vitreoretinal relationship identified by OCT, three (11%) of 27 fellow eyes in patients with unilateral idiopathic macular hole developed a full-thickness macular hole.     

Dome-shaped detachment of premacular vitreous cortex in macular hole development

PURPOSE: To clarify the role of the posterior vitreous cortex in macular hole development, we evaluated the follow-up findings of clinical observations and optical coherence tomography (OCT) images of macular holes in early stage. METHODS: The vitreoretinal tomography was examined and followed in eyes with stage 1 and 2 macular holes with OCT. RESULTS: The posterior cortical vitreous was identified in 12 of 17 eyes with early-stage macular holes by OCT (71%). In these eyes, the detached posterior vitreous appeared to be merged to the fovea and the disc. The vitreoretinal separations showed typically dome-shaped. A long scan along the papillomacular axis also delineated the posterior vitreous face as dome-shaped perifoveal vitreous detachment with adhesion to the fovea and disc. Repetitive OCT examinations clearly demonstrated the course of development of the macular hole. CONCLUSIONS: The dome-shaped vitreoretinal separation seen with OCT gives rise to an idea that the posterior vitreous cortex may not be taut but slack, and would not cause a continuous tractional force even in early-stage macular holes. This finding brings us an idea that the tangential traction at the fovea may be generated by fluid movements, rather than by contraction of the cortical vitreous.     

特发性黄斑裂孔对侧眼的观察分析

目的 应用光学相干断层扫描(optical coherence tomography,OCT)对特发性黄斑裂孔患者对侧眼的后极部视网膜与玻璃体的扫描,观察其早期变化及演变过程分析.方法 对45例临床已确诊的特发性黄斑裂孔患者的对侧眼进行OCT扫描.结果 45例患者对侧45只眼中,23只眼有异常,OCT扫描后显示其中8只眼为1～2期单纯玻璃体后脱离(posterior vitreous detachment,PVD),3只眼为3期PVD,4只眼为1期黄斑裂孔,5只眼为2期黄斑裂孔,3只眼为3期黄斑裂孔,未发现4期黄斑裂孔,其余22只眼未见明显异常表现.随访一年半后发现1期黄斑裂孔的2只眼、2期黄斑裂孔的4只眼,1～2期PVD的2只眼进展为3～4期黄斑裂孔(共8只眼进展为3～4期黄斑裂孔),1期黄斑裂孔1只眼进展为2期黄斑裂孔,22只正常眼中有4例发现1～2期PVD,其余未见异常改变.结论 特发性黄斑裂孔有双眼发病的可能,对侧眼发生黄斑裂孔的可能性应引起重视,利用OCT可以对其黄斑区玻璃体视网膜关系进行观察、随访,并且评估其发生黄斑裂孔的可能性及危险性,可以适时采取干预措施.

Abstract：

Objective Using OCT (optical coherence tomography, OCT) to scan the posterior retina and vitreous, investigate the initial changes and developing process. Methods The fellow eyes of 45 patients with unilateral full-thickness macular holes were examined by OCT. Results In the 45 eyes, 23 eyes were abnormity observed by OCT. OCT images showed that among the 23 initially diseased eyes the number of posterior vitreous detachment of 1-2 and 3stages was respectively 8 and 3 eyes, macular hole of 1, 2, 3 stages was respectively 4, 5, and 3 eyes, there was not stage 4 macular hole. After one year and a half fellow-up, among the 23 abnormity eyes, 8 eyes developed a full-thickness macular hole, and 4 eyes of the other 22 normal eyes developed a posterior vitreous detachment. Conclusions It is possible that idiopathic macular hole development in fellow eyes of patients with unilateral macular hole should attract our attention. Posterior vitreoretinal relationship can be observed and follow-up by OCT, and to assess the likelihood of occurrence of macular holes and risk, guide our interventions.     

Posterior vitreous detachment and macular hole formation in myopic foveoschisis

PURPOSE: To report two cases of macular hole (MH) associated with myopic foveoschisis (MF). DESIGN: Interventional case report. METHODS: Two women presented with metamorphopsia. Preoperative optical coherence tomography (OCT) showed an MH and MF. We performed vitrectomy, internal limiting membrane (ILM) peeling and gas tamponade. RESULTS: Preoperative OCT examination and intraoperative microscopic observation revealed partial posterior vitreous detachment (PVD) at the posterior retina and vitreous strands adhering to the edge of the MHs. The MF resolved in both patients, but the MHs remained open postoperatively. CONCLUSIONS: Although the contribution of tangential traction cannot be excluded, the mechanism of MH formation in eyes with MF may be anteroposterior traction via abnormal vitreofoveal adhesion resulting from partial PVD.     

Vitreoretinal tomography and foveolar traction in macular hole development and macular pseudohole]

OBJECT: To clarify the morphologic features and foveolar traction in macular hole development and macular pseudohole. METHODS: The vitreoretinal tomography of idiopathic macular holes and macular pseudoholes was observed with optical coherence tomography (OCT). RESULTS: In stage 1 and 2, foveolar intraretinal splitting was evident. The posterior hyaloid membrane was detected in 7 of 10 eyes with stage 1 and 2 holes. Dome-shaped vitreoretinal separation was seen in 6 of 7 eyes in which the posterior hyaloid membranes were detected. A complete posterior vitreous detachment was seen around a stage 3 hole. In the macular pseudohole with preretinal membrane, there was anterior and central displacement of the inner retina in the perifoveal region, resulting in a U-shaped deformation of the macular lesion. In contrast, the structure of the central fovea was virtually intact. CONCLUSIONS: On the basis of the OCT findings, the intraretinal splitting and the cyst formation are important features in the development of a macular hole. The dome-shaped vitreoretinal separation in the early stages of macular holes suggests that the posterior hyaloid membrane may not be taut but slack, and would not cause a tractional force continuously even in early-stage macular holes.     

外伤性黄斑裂孔的光学相干断层成像特征

目的 :分析外伤性黄斑裂孔的光学相干断层成像特征。方法 :18例黄斑裂孔患者 (18眼 )行OCT检查。结果 :17例外伤性黄斑裂孔均未见玻璃体后脱离 (PVD) ,裂孔边界整齐 ,无明显视网膜脱离。 7例裂孔边缘可见神经上皮脱离的轮化 ,10例未见晕轮。结论 :年轻的外伤性黄斑裂孔患者不易发生视网膜脱离 ,定期检查OCT有助于外伤性黄斑裂孔治疗方式的选择。     

Optical coherence tomography evaluation of idiopathic macular hole treatment by gas-assisted posterior vitreous detachment

PURPOSE: To report a series of patients with Stage II macular hole (MH) treated by gas-assisted posterior vitreous detachment (GAPVD). DESIGN: Interventional case series. METHODS: Six patients (six eyes) with Stage II MH were submitted to a 0.4 ml perfluoropropane (C(3)F(8)) intravitreal injection. Comprehensive ophthalmic examination including best-corrected visual acuity, fundus photography, and optical coherence tomography (OCT) was performed at baseline and one, three, and six months after the procedure. RESULTS: Preoperative OCT revealed Stage II MH in all cases. In five cases, improvement in visual acuity and closure of the macular hole on OCT was observed at one, three, and six months after GAPVD. In one case, although vitreofoveal traction was released, MH closure was not achieved; a full-thickness retinal defect persisted and final visual acuity was 20/100. CONCLUSION: GAPVD may be a viable alternative treatment for Stage II MH.     

Delineation of the vitreous and posterior hyaloid using bromophenol blue

PURPOSE: To describe visualization of the vitreous and the posterior hyaloid membrane using bromophenol blue during vitrectomy for macular hole and retinal detachment. PATIENTS AND METHODS: Six patients with macular holes and four with retinal detachments were included in the study. Before and after surgery, complete clinical examination, including funduscopy and measurements of best-corrected visual acuity and intraocular pressure, was performed. Additional functional tests, such as fluorescein angiography, optical coherence tomography (Stratus OCT; Carl Zeiss Meditec, Jena, Germany, Germany), Goldmann perimetry, and multifocal electroretinography as well as photography of the posterior pole, were performed for macular hole patients. Bromophenol blue was used in concentrations of 0.2%. During macular hole surgery, the dye was injected into the air-filled globe, while during surgery for retinal detachment, the globe was partially filled with perfluorocarbon before dye injection after induction of a posterior vitreous detachment to stain the vitreous peripherally. RESULTS: Bromophenol blue provided sufficient staining of the attached posterior hyaloid membrane and vitreous remnants in the periphery. This was especially helpful for patients in whom a posterior vitreous detachment could not be induced mechanically by suction using the vitrectomy probe alone, as seen in three of six interventions for a macular hole in this series. In addition, staining of the vitreous or vitreous remnants in the periphery and at the vitreous base was seen in all patients and helped to completely remove the vitreous in a controlled fashion. After macular hole surgery, increase of visual acuity from 20/100 (mean) to 20/40 was seen during follow-up up to 6 months. In one case, the hole persisted and required a second operation. Finally, closure of the hole was achieved in all patients. After retinal detachment surgery, reattachment was achieved in all cases. No dye-related adverse events were seen during follow-up as shown by the functional tests (visual acuity measurement, electroretinography, and perimetry) applied. CONCLUSION: Delineation of the vitreous and the posterior hyaloid using bromophenol blue staining greatly facilitates vitreoretinal procedures. Bromophenol blue appeared to be a very helpful and safe tool to visualize the posterior hyaloid membrane in macular hole surgery and assured its complete separation from the retinal surface. The dye also helped to remove vitreous at the vitreous base during retinal detachment surgery. Therefore, bromophenol blue appears as a very good alternative to triamcinolone, which has been used for this purpose, because the dye has no pharmacological properties and no side effects are likely to occur such as cataract formation and increase in intraocular pressure. Further studies including larger numbers of patients are mandatory.     

Mapping posterior vitreous detachment by optical coherence tomography in eyes with idiopathic macular hole

PURPOSE: To determine the relationship between posterior vitreous detachment and idiopathic macular hole. DESIGN: Observational case series. METHODS: In a prospective study, the posterior hyaloid face was scanned from the posterior pole to the far periphery by optical coherence tomography in 25 eyes (22 patients) with an idiopathic macular hole (stage 1 = 1, stage 2 = 7, stage 3 = 10, and stage 4 = 7), and a map of the posterior vitreous detachment was constructed. RESULTS: One eye with a stage 1 macular hole had a posterior vitreous detachment confined to the vascular arcade, but attached to the fovea. In all seven eyes at stage 2, the detached posterior hyaloid enlarged upward beyond the superior vascular arcade, but stopped at the margin of inferior vascular arcade. In two cases, the posterior vitreous detachment also extended temporally and superonasally. In all cases, the vitreous face remained attached to the fovea. Six of the 10 eyes at stage 3 had larger partial posterior vitreous detachment that extended not only upward, but also beyond the inferior vascular arcade, while in the other four eyes, the size and position of the posterior vitreous detachment was similar to stage 2 macular holes. However, unlike stage 2, the posterior vitreous detachment included the fovea in all eyes. All seven eyes with a stage 4 macular hole had complete posterior vitreous detachment that extended to the far periphery in all directions. CONCLUSION: There is a close correlation between the stage of the macular hole and the degree of posterior vitreous detachment. This close correlation suggests that progression of idiopathic macular hole is related to enlargement of the posterior vitreous detachment.