Macular hole following cataract extraction

Macular hole formation is a rare complication of cataract extraction. Although the exact etiology is unclear, macular holes can be classified into pre-existing holes that may not have been visible prior to cataract surgery, early stage macular holes that progressed to a more advanced stage, symptomatic holes following cataract extraction, and de novo symptomatic macular holes. Antero-posterior (A-P) tractional forces as well as macular edema are thought to play a role in the pathogenesis of these macular holes. In the traction hypothesis, A-P forces are thought to induce either an acute detachment of the posterior cortical gel or significant traction of the vitreous gel around the fovea, resulting in formation, or rapid progression of, macular holes. In late reopening of macular holes after cataract extraction, subclinical macular edema and epiretinal membrane formation have been suggested as possible causes. Current treatment options, including combining cataract extraction with macular hole repair, are reviewed.