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.     

Spontaneous outer retinal closure of stage 1B macular hole without vitreofoveal separation

A 65-year-old patient complained of central metamorphopsia and presented an intraretinal cyst with a yellow ring in the fovea of the right eye. His best-corrected visual acuity was 20/32 in that eye. Optical coherence tomography (OCT) 3 showed an enlarged pseudocyst at the outer retina of a stage 1B macular hole; the foveal roof was intact where the vitreous was attached reflecting a perifoveal posterior vitreous detachment. Six months later, OCT 3 showed bridging by centripetal protrusion in the outer fovea inside the pseudocyst with a residual defect in the foveal photoreceptor layer. Eighteen months after the initial visit, spectral-domain OCT showed bridging of the outer retina inside the pseudocyst at the hyper-reflective line representing the external limiting membrane; the roof of the pseudocyst was more elevated with posterior hyaloid adhesion and there was a smaller residual defect in the foveal photoreceptor layer. This case demonstrates that spontaneous closure in the outer retina may develop in some cases of stage 1B macular holes without vitreofoveal separation.     

Tomographic features of early macular hole closure after vitreous surgery

PURPOSE: To report the optical coherence tomographic features of macular hole closure in the first months after vitreous surgery. METHODS: We studied prospectively the tomographic features of 28 eyes (28 patients) with idiopathic macular holes before and after vitreous surgery by optical coherence tomography. We compared the best-corrected visual acuity levels with the postoperative tomographic features. RESULTS: The 25 eyes with successfully sealed macular holes had one of two tomographic features within 1 month postoperatively: simple closure (normal foveal configuration) in 14 eyes (56%) or a bridge formation at the fovea that mimicked a foveal retinal detachment in 11 eyes (44%). It took an average of 2.0 months (range, 0.8 to 3.5 months) for the bridge tissue to attach to the retinal pigment epithelium. Best-corrected visual acuity quickly improved in the former group; visual improvement began 1 month after attachment of the bridge tissue in the latter group. A closed hole reopened 4 months postoperatively in one eye with a bridge formation. CONCLUSIONS: Idiopathic macular holes have one of two patterns early after surgical closure, simple closure or a bridge formation. Visual improvement starts after the fovea assumes a normal configuration. The bridge formation appears to reflect an early phase and fragile condition in the anatomic closure of macular holes.     

Reversibility of the early stages of idiopathic macular holes

Three patients had a history of unilateral acute visual loss accompanied by clinical and fluorescein angiographic findings compatible with foveal sensory retinal detachment secondary to vitreofoveal traction. The reversibility of this early stage of idiopathic macular hole formation in all three eyes was associated with spontaneous release of vitreofoveal traction and with improvement in visual acuity. A localized detachment of the vitreous from the sensory retina in the macula with an associated vitreous condensation overlying the macula was evident in all three cases.     

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.     

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。     

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.     

外伤性黄斑裂孔的随诊观察

目的 探讨外伤性黄斑裂孔的自然病程和视力预后.方法 系列病例报告.对2004年8月至2007年12月确诊的28例(28只眼)外伤性黄斑裂孔患者进行定期随诊.观察项目包括视力、眼底彩色照相及相干光断层扫描(OCT)情况.其中随诊时间不足3个月的患者排除.结果 28例(28只眼)外伤性黄斑裂孔患者均符合入选条件,随诊时间在3个月以上,平均随诊时间14个月.28例(28只眼)中,有16例(16只眼,57.1%)同时伴有黄斑裂孔周围脉络膜视网膜损伤.在随诊中,9例(9只眼)黄斑裂孔变大;1例(1只眼)黄斑裂孔变小;3例(3只眼)黄斑裂孔自行闭合,闭合时间分别在随诊4.5、3.5及1.0个月后,闭合率10.7%(3/28),患者视力均提高,最终视力为0.5～0.7;2例(2只眼)发生视网膜脱离,发生率4.2%(2/48),经手术治疗后,视网膜复位,视力提高.结论 外伤性黄斑裂孔的大部分患者在随诊期间视力稳定甚至有所提高.在发病后的4～5个月内,部分患者的黄斑裂孔可自行闭合,并恢复较好的视力,而发生视网膜脱离者较少.     

Traction-induced foveal damage predisposes eyes with pre-existing posterior vitreous detachment to idiopathic macular hole formation

Aim

To propose a new mechanism for the development of idiopathic macular hole in the setting of pre-existing posterior vitreous detachment (PVD).

Methods

Patients were examined clinically with fundus contact lens biomicroscopy and high-definition optical coherence tomography (OCT) was used to characterize the structural changes in the fovea following PVD.

Results

Two patients presented with vitreofoveal separation and were found by high-definition OCT to have subtle foveal disruption and irregularity of the foveal contour with no evidence of a full thickness macular hole. Sequential examination of these patients demonstrated delayed formation of idiopathic macular hole.

Conclusion

Traction-induced inner foveal damage occurring before or coincident with spontaneous vitreofoveal separation destabilizes the fovea and predisposes some eyes to delayed macular hole formation.     

OCT检查在外伤性黄斑裂孔中的应用

目的:观察光学相干断层成像技术(optical coherence tomography,OCT)在外伤性黄斑裂孔中的应用.方法:选择2015-01/2017-01来我院就诊的外伤性黄斑裂孔患者23例25眼,其中9眼未行手术治疗,16眼行手术治疗.采用OCT检查仪分析手术前后其图像特征.结果:外伤性黄斑裂孔患者OCT表现为神经上皮层部分或全层消失.均未见玻璃体后脱离,黄斑裂孔均未见牵引作用.其中黄斑部分缺损者4眼,黄斑全层裂孔者21眼.OCT检查发现全层黄斑裂孔表现:单纯性黄斑裂孔4眼,黄斑区全层裂开伴周围神经上皮水肿10眼,黄斑区全层裂孔伴神经上皮层局限性脱离7眼.25眼外伤性黄斑裂孔患者中,9眼未行手术治疗,其中7眼自行愈合;16眼行手术治疗,术后复查OCT显示裂孔愈合,其中12眼黄斑结构大致正常,视力平均提高了3行,4眼视网膜神经上皮层变薄,视力较术前没有明显改善.结论:OCT检查在外伤性黄斑裂孔的诊断和治疗中非常必要.     

Three-dimensional observations of developing macular holes

PURPOSE: To describe the morphologic features of idiopathic macular holes and vitreous traction during macular hole evolution. METHODS: We prospectively examined 89 eyes of 82 patients with idiopathic macular holes (stage 1, 15 eyes; stage 2, 16 eyes; stage 3, 50 eyes; stage 4, eight eyes) using optical coherence tomography. In addition to optical coherence tomography, scanning laser ophthalmoscopy was performed in all 15 eyes with stage 1 hole, six of 16 eyes with stage 2, and 19 of 50 eyes with stage 3. RESULTS: In stage 1 eyes, optical coherence tomography revealed retinal split or cystic changes at the fovea in 11 of 15 eyes (73%) and foveal retinal detachment in four eyes (27%). Two eyes with foveal cysts progressed to stage 2, and one developed a stage 3 hole. In one eye with retinal detachment, the detached retina thinned and developed dehiscence. Optical coherence tomography showed a vitreous cortex that was detached in the perifoveal area but attached on the fovea in 11 of the 15 stage 1 eyes. In stage 2 macular holes, retinal tissue extending from the perifoveal retina formed a flap. Scanning laser ophthalmoscopy demonstrated intraretinal radiating striae, which corresponded to a foveal cyst or perifoveal cystic changes. CONCLUSIONS: Macular holes start as retinal splits or foveal cysts in most cases. The anterior wall of the cyst serves as a flap in stage 2 and an operculum in stage 3 holes. Radiating striae correspond to retinal splits or cysts and presumably represent an elevation of Henle fiber. In a few macular holes, foveal detachment is the initial change. The detached retina thins and eventually develops a hole. In both courses, anterior traction of the slightly detached vitreous cortex appears to be a major contributing factor to macular hole formation.     

Resolution of diabetic cystoid macular edema associated with spontaneous vitreofoveal separation

PURPOSE: To report spontaneous resolution of diabetic cystoid macular edema (CME) associated with spontaneous vitreofoveal separation. DESIGN: Interventional case series. METHODS: Optical coherence tomography (OCT) was performed on three eyes of three diabetic patients with CME before and after vitreofoveal separation. RESULTS: In all three eyes, OCT showed cystic changes at the fovea with a slightly detached posterior hyaloid, which remained attached to the optic disk and the fovea. After spontaneous separation of the hyaloid at the fovea, there was resolution of the cystic cavities and restoration of the foveal depression. CONCLUSIONS: In some eyes of diabetic patients, CME is caused by a vitreous traction. Resolution of CME may occur after spontaneous vitreofoveal separation.     

Optical coherence tomography images of spontaneous macular hole closure

PURPOSE: To investigate optical coherence tomography images of spontaneous macular hole closure. METHOD: Case report. In a 60-year-old woman with full-thickness macular hole, posterior vitreous detachment, and previous branch retinal vein occlusion, we observed the entire course of spontaneous macular hole closure by use of optical coherence tomography. RESULTS: Spontaneous macular hole closure began as the inward protrusion of the tissue around the margin of the macular hole. The protruding tissue then connected to bridge the macular hole, which mimicked a foveal retinal detachment. The bridged tissue gradually thickened, and the foveal detachment and perifoveal cysts resolved. The fovea eventually regained its normal configuration. CONCLUSIONS: The bridging of the protruding retinal tissue over the macular hole plays a key role in spontaneous macular hole closure.     

Surgical management of traumatic macular hole-related retinal detachment

PURPOSE: To investigate the clinical characteristics and surgical outcome of traumatic macular hole-related retinal detachment. DESIGN: Retrospective, interventional case series. METHODS: Eight eyes of eight patients with traumatic macular hole-related retinal detachment underwent vitrectomy combined with gas tamponade, either initially or subsequently. Anatomic re-attachment of the retina, closure of traumatic macular hole, and visual outcome were measured. RESULTS: Successful retinal re-attachment was achieved in seven eyes (87.5%), and the macular hole was successfully closed in all eyes (100%). Improved vision after the surgery was noted in five eyes (62.5%), whereas three eyes (37.5%) displayed no change. CONCLUSIONS: Vitrectomy combined with gas tamponade appears to give an effective anatomic re-attachment rate for traumatic macular hole-related retinal detachment. The presence of peripheral retinal breaks, vitreous hemorrhage, or the extent of retinal detachment has no discernible significant influence on closure rate of macular hole and retinal re-attachment rate.     

Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis

PURPOSE: To evaluate the efficacy of vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. DESIGN: Retrospective comparative interventional case series. PARTICIPANTS: Seven patients (nine highly myopic eyes) with posterior staphyloma with foveal detachment and retinoschisis without macular hole. Preoperative best-corrected visual acuity in nine eyes ranged from 0.02 to 0.4 (average, 0.17). METHODS: Vitreous surgery performed on all nine eyes consisted of core vitrectomy, surgically induced posterior vitreous detachment (three eyes), removal of the premacular vitreous cortex and internal limiting membrane in the posterior staphyloma, and 30% SF(6) gas tamponade. Patients were instructed to maintain a prone position for at least 1 day after surgery. The postoperative follow-up period ranged from 6 to 42.5 months (average, 20.4 months). MAIN OUTCOME MEASURES: Visual acuity, retinal tomography monitored by optical coherence tomography. RESULTS: In eight of the nine eyes, foveal detachment and retinoschisis gradually decreased in height, and these eyes finally attained foveal attachment and visual improvement within 6 months postoperatively. The postoperative best-corrected visual acuity of these eight eyes ranged from 0.4 to 0.6 (average, 0.48). One eye developed a full-thickness macular hole during vitreous surgery, and its postoperative best-corrected visual acuity was 0.08. CONCLUSIONS: Foveal detachment and retinoschisis in highly myopic eyes resolved after vitrectomy. Vitreous surgery might have a rationale as prophylactic treatment for highly myopic eyes at high risk of macular hole development.     

Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes

PURPOSE: Macular holes cause retinal detachments in highly myopic eyes. Because degenerative macular changes often coexist, biomicroscopic evaluation of macular hole status after retinal reattachment is sometimes difficult. We studied macular holes with retinal detachment after vitrectomy using optical coherence tomography and evaluated the anatomic status of the hole and factors associated with anatomic success. DESIGN: Retrospective, nonrandomized, comparative study. PATIENTS: Sixteen eyes that underwent vitrectomy for retinal detachment associated with a macular hole were included. Internal limiting membrane peeling with indocyanine green was performed in 14 eyes; the epiretinal membrane was peeled with a diamond-dusted membrane scraper alone in two eyes. All retinas reattached postoperatively. The follow-up period at the optical coherence tomography examination was at least 6 months. METHODS: Optical coherence tomography was performed vertically and horizontally, and the presence of a persistent macular hole was determined. Other information was obtained from patient records. RESULTS: The macular holes closed in seven of 16 eyes (44%). Age, sex, axial length, preoperative best-corrected visual acuity, duration of symptoms, preoperative refractive error, and the preoperative area of the retinal detachment were not significantly correlated with hole closure. Improved postoperative best-corrected visual acuity (P <.05) was significantly associated with macular hole closure, and more frequent visual improvement (P =.06) was of borderline significance. CONCLUSIONS: The success rate was lower than those obtained in eyes without myopia or in myopic macular holes without retinal detachments. Macular hole closure may predict improved visual outcome for patients with retinal detachment and macular holes. Optical coherence tomography detects persistent macular holes in highly myopic eyes with retinal detachment.     

Darstellung vitreoretinaler Adhärenzen in Partneraugen von Patienten mit durchgreifenden Makulaforamina in der optischen Kohärenztomographie

Background. Vitreoretinal adhesions play a crucial role in the development of a macular hole. To visualize vitreoretinal adhesion we used optical coherence tomography to investigate fellow eyes of patients with macular holes. Methods. In a prospective study we scanned the retina in 188 patients with a macular hole stage III or IV (Gass classification). The foveal shape and vitreous were classified into grades. Results. Of the 188 patients 45% showed no vitreous reflex, 45% a partial vitreous detachment with foveolar adhesions, and 10% a vitreous detachment with complete separation from the fovea. While eyes with normal foveolar shape displayed partial vitreous detachment in 33%, this figure rose to 66% in eyes with a macular hole stage I. Conclusion. Diffuse thickening of the fovea is followed by an intraretinal split and formation of a cyst. The shape of the foveolar adhesion suggests that continuing anteroposterior vitreal traction leads to a retinal break and formation of a full-thickness macular hole.     

Macular hole formation, spontaneous closure, and recurrence in a previously vitrectomized eye

PURPOSE: To report a case of recurrent idiopathic macular hole after spontaneous closure in a previously vitrectomized eye. DESIGN: Case report. METHODS: A 69-year-old woman who had had vitrectomy for vitreous hemorrhage seven years earlier presented with decreased visual acuity and a macular hole. The hole spontaneously resolved within four months. One year later, the macular hole reopened. Internal limiting membrane peeling was performed, resulting in return of visual acuity. Optical coherence tomography (OCT) was obtained during all visits. RESULTS: Initial OCT revealed a macular hole with perifoveal cystoid degeneration and bridging elements. At subsequent visits, OCT showed resolution of the cystoid degeneration. The preoperative OCT demonstrates recurrence of the macular hole with similar perifoveal abnormalities. CONCLUSIONS: After vitrectomy, anteroposterior vitreofoveal traction associated with most macular hole formation does not apply. OCT demonstrates foveal structure and forces coincident with hole formation and resolution. Dynamic interaction between tensile and degenerative forces, and proliferative and reparative glial elements, may lead to hole remodeling.     

Spontaneous resolution of traumatic macular hole-related retinal detachment

PURPOSE: To report a case of spontaneous resolution of traumatic macular hole-related retinal detachment. DESIGN: Observational case report. METHODS: Clinical examination and optical coherence tomographic (OCT) evaluation of a patient who experienced spontaneous resolution of a retinal detachment resulting from a traumatic macular hole. RESULTS: A 12-year-old boy developed a macular hole and retinal detachment after blunt ocular trauma. Spontaneous reattachment of the retina and closure of the macular hole were documented at clinical examination and by OCT three weeks after presentation. CONCLUSIONS: Spontaneous closure of traumatic macular hole and resolution of associated retinal detachment can occur.     

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.