[The state of the vitreous in idiopathic macular holes]

We examined the vitreous of 37 eyes of 31 patients with macular holes of various stages. There was no posterior vitreous detachment (PVD) in 18 of 18 impending and 19 of 20 newly formed macular holes. In newly formed macular holes, the operculum was located either at the level of or immediately anterior to the retinal surface. The gel component of the vitreous was always separated from the posterior fundus by intervening liquefied lacuna, simulating PVD. However, the cortical vitreous was located posterior to the liquefied lacuna and remained attached to the retina. PVD failed to develop in all of 15 eyes during the follow-up period of 3 months after formation of a macular hole. The incidence of PVD increased in the eyes with macular holes lasting for 1 year or longer. In our present series, PVD in its classical sense did not contribute to the pathogenesis of macular holes as it developed after formation of the latter. Instead, a subtle anterior displacement of vitreous cortex strictly confined to the area of the fovea seemed to trigger the development of idiopathic macular holes.