Idiopathic macular hole: a clinical review and current concepts in the diagnosis and management

A full-thickness macular hole is a retinal opening involving the fovea causing severe central vision loss among the elderly.

This paper examines the pathogenesis and mechanistic constructs for the development and formation of idiopathic macular hole, reviews the stages of evolution, and provides guidelines for management by the primary care clinician. An update of the current methods of diagnosis and the criteria for surgical intervention, including vitrectomy and epiretinal membrane removal are presented. A perspective on the emerging trends in the treatment of macular hole using transforming growth factor beta-2 application is also introduced.

Clinical practice guidelines for the management of patients with macular holes can be established based on an improved understanding of the pathogenesis of macular hole formation, a knowledge of the various stages of evolution, and the primary care clinician's familiarity with improved diagnostic techniques. An enhanced understanding of the pathogenesis of macular hole will help to predict the risk for the fellow eye, will promote more effective patient education and counseling, and will result in more timely surgical intervention.

More promising results in the surgical closure of macula holes can prevent or minimize significant central vision loss.