Different modes of full-thickness macular hole formation

Area of Science:

• Ophthalmology
• Retinal Imaging
• Macular Diseases

Background:

• Full-thickness macular holes (FTMH) are a significant cause of vision loss.
• The diverse mechanisms of FTMH development and the role of edematous cysts are not fully understood.

Purpose of the Study:

• To investigate and describe the different modes of FTMH formation using spectral-domain optical coherence tomography (SD-OCT).
• To explore the relationship between morphological alterations and visual acuity in eyes with FTMH.

Main Methods:

• Retrospective case series of 30 eyes from 30 patients.
• Utilized spectral-domain optical coherence tomography (SD-OCT) to analyze FTMH formation and morphology.
• Examined morphological alterations in 5 established FTMH cases.

Main Results:

• Identified multiple FTMH formation pathways, including anterior hyaloidal traction, outer lamellar hole (OLH) development, degenerative lamellar hole (DLH) progression, and epiretinal membrane (ERM) traction.
• Observed that FTMH formation can be associated with foveal pseudocysts, serous retinal detachment, and detachment from the retinal pigment epithelium (RPE).
• Found an inverse correlation between best-corrected visual acuity (BCVA) and FTMH size (base and minimum diameters) and foveal wall height, with base diameter showing the strongest correlation.

Conclusions:

• FTMH can develop through various mechanisms driven by hyaloidal or ERM traction, or following serous retinal detachment.
• Edematous cysts in foveal walls may develop post-FTMH due to impaired fluid clearance, potentially enlarging the hole.
• Visual acuity in eyes with OLH or FTMH is primarily determined by the size of the central photoreceptor-free area.