Histopathologic features of idiopathic macular holes and cysts

The pathogenesis of idiopathic macular holes and cysts is currently debated. The authors studied the histopathologic features of 41 specimens. Of 22 full-thickness holes, 16 (73%) had epiretinal membranes (ERMs), 15 (68%) had cystoid macular edema (CME), and 3 (17%) were sealed by fibroglial and retinal pigment epithelial hyperplasia. Photoreceptors were variably degenerated, for a mean of 480 microns (range, 200-750 microns) from the hole margins. Of 12 lamellar macular holes, 6 (50%) had an ERM exhibiting tangential traction on the internal limiting membrane. Cystoid macular edema was present in five (71%) of seven macular cysts, and an ERM was noted in only one (14%). The authors' results suggest that ERM tangential traction may play a role in the pathogenesis of lamellar macular holes. Macular holes often have associated ERMs and CME, which may be potentially reversible.