MACULAR HOLE

SHASHIKIRAN S
ROLL NO:110
 OBJECTIVES

1. DEFNITION
2. CAUSES
3. CLINICAL FEATURES
4. MANAGEMENT
 DEFNITION

• IT REFERS TO THE PARTIAL OR FULL THICKNESS HOLE IN THE

NEUROSENSORY RETINA IN THE FOVEAL REGION .
 CAUSES

1. SENILE OR IDIOPATHIC MACULAR HOLES (83%) ,ARE MORE COMMON IN

FEMALES AGED 60-80 YEARS
2. TRAUMATIC MACULAR HOLES (5%) CASES
3. OTHER CAUSES :CYSTOID MACULAR OEDEMA , VITREOMACULAR TRACTION,
POST SURGICAL MYOPIA ,POST LASER TREATMENT, EPIRETINAL MEMBRANE
TRACTION AND POST INFLAMMATORY
 CLINICAL
FEATURES

SYMPTOMS
1.DECREASED VISON
2.DISTORTION OF VISION MAY BE THERE
3.CENTRAL SCOTOMA MAY BE REPORTED BY SOME PATIENTS
 SIGNS

• AMSLER GRID TEST SHOWS A CENTRAL SCOTOMA

• WATZKE-ALLEN TEST A THIN LINE OF LIGHT IS PROJECTED OVER THE MACULA
WITH A SLIT LAMP AND THE PATIENT IS ASKED TO REPORT ON HIS APPEARANCE .
A LINE APPEARING BROKEN MAY INDICATE A MACULAR HOLE
• BASED ON THE FUNDUS APPEARANCE MACULAR HOLES CAN CLASSIFIED INTO 4
STAGES
 GASS CLASSIFICATION OF MACULAR HOLES

• STAGE 1 OR IMPENDING HOLE

• IT IS CHARACTERIZED BY ABSENT FOVEAL REFLEX AND A YELLOW SPOT
• OCT EXAMINATION REVEALS A PSEUDOCYST WITH A VITREOUS DETACHMENT
0923
STAGE
2
• A SMALL FULL THICKNESS HOLE ON EITHER SIDE IN THE CENTRE OF RING OR AT
THE MARGIN OF RING
 STAGE
3
• A FULL THICKNESS HOLE IS SEEN AS REDDISH SPOT SURROUNDED BY A GREY
HALO RETINAL FLUID , BUT NO PVD
STAGE 4

• FULL THICKNESS HOLE WITH SRF CUFF AND COMPLETE PVD

 MANAGEMENT

DIFFERENTIAL DIAGNOSIS
1.SOLAR RETINOPATHY
2.NTRARETINAL CYST
3.VITREOUMACULAR TRACTION SYNDROME .
 INVESTIGATIONS

1.FUNDUS FLUORESCEIN ANGIOGRAPHY

FOVEAL HYPERFLUORESCENCE WITH OUT LEAK IN THE LATE PHASE IN PATIENTS WITH
STAGE 2 TO 4 MACULAR HOLES
2.OPTICAL COHERENCE TOMOGRAPHY (OCT):USED FOR
1.DIFFERENTIATING TRUE HOLES FROM LAMELLAR HOLES AND CYSTS
2.STAGING OF MACULAR HOLES
3.DETERMINING THE DEGREE OF TRACTION
4.PLANNING OF SURGERY
 TREATMENT

• STAGE 1:TREATMENT IS NOT RECOMMENDED AS SPONTANEOUS HOLE CLOSURE

CAN OCCUR BUT CLOSE FOLLOW- UP IS ADVISED
• STAGE 2 TO 4 :HOLES OF RECENT ONSET SHOULD BE TREATED WITH PARS PLANA
VITRECTOMY WITH POSTERIOR HYALOID REMOVAL
 PROGNOSIS

• ANATOMICAL CLOSURE IS REPORTED IN 80-90 %OF CASES

• VISUAL IMPROVEMENT IS REPORTED IN 70% OF CASES WITH RECENT HOLES
 COMPLICATIONS OF SURGERY

• OCCURRENCE OF PROGRESSION OF CATARACT

• OTHER REPORTED COMPLICATIONS INCLUDE ; RETINAL BREAKS , RETINAL
DETACHMENT , LATE REOPENING OF HOLES
THANK YOU