Idiopathic Macular Hole without Vitreomacular Separation

Abstract

Purpose: To investigate the clinical features and treatment outcomes of idiopathic full thickness macular hole (FTMH) without vitreomacular separation (VMS). Methods: Consecutive cases of idiopathic FTMH at one tertiary center from January 2013 to April 2020 was retrospectively recruited. They were separated into two groups according to the findings in optical coherence tomography (OCT): FTMH with VMS and FTMH without VMS. Ophthalmic examinations and OCT were performed pre and postoperatively. The clinical findings were compared between two groups. Results: Of the total 124 cases, 15 (12.1 %) were noted as FTMH without VMS with the presence of an attached posterior hyaloid (PH) at macula. The macular hole (MH) size was smaller (276.06 ± 170.10 µm) compared to those with VMS (492.83 ± 209.31 µm) (P < 0.001). The incidence of lamellar hole associated epiretinal proliferation (LHEP) was much higher in this group (13/15, 86.7%), compared to FTMH with VMS (11/109, 10.1%) (P < 0.001). A higher rate of spontaneous closure of MH (13.3%) was also noted in FMTH without VMS (13.3% vs 0.9% in FTMH with VMS, P = 0.040). After operation, the MH closure rate was 93.3%. The postoperative best-corrected visual acuity was not significantly different between two groups (P = 0.098). Conclusions: A small percentage (12.1% in this series) of idiopathic FTMH had no VMS. The completely attached PH along with the high incidence of LHEP implied a tangential traction in FTMH without VMS. The MH size was usually small, and the postoperative outcomes was similar to those of conventional FTMH with VMS.

Full-Thickness Macular Hole With Persistent Broad Vitreomacular Attachment

“…Therefore, the cases reported by Takahashi et al 11 may not be the same as those shown here. In a recent study by Ang et al, 10 15 of 124 FTMH eyes (12.1%) operated on over 8 years had broad adhesions to the macula, which seems much higher than the frequency in our report. They speculate that the reason for the high frequency is that a large number of atypical cases are referred to them as regional referral centers.…”

“…In a report of 26 FTMH eyes with EP, Bae et al 9 found that a significant proportion of MHs with EP manifested relatively broad adhesion of the vitreous to the circumference of the perifoveal area and shallow vitreous detachment outside of it. Recently, Ang et al 10 described 15 FTMH eyes without vitreomacular separation and reported that these patients tended to be younger and had better preoperative visual acuity than patients with classical MH with vitreomacular separation.…”

Optical coherence tomography angiography features in patients with idiopathic macular holes before and after vitrectomy

“…Inclusion criteria were: (1) equivalent spherical diopter < -1.0D and OCT showing a full-thickness retinal break in the macular zone; (2) vitrectomy combined with intraocular gas lling performed in our hospital. Exclusion criteria were: (1) macular holes in both eyes; (2) high myopia macular holes; (3) traumatic macular holes; (4) macular rhegmatogenous retinal detachment; (5) recurrent macular holes or unclosed holes after operation; (6) patients with macular membrane; (7) lamellar macular holes; (8) previous history of other fundus diseases; (9) a history of glaucoma; (10) OCTA image quality value Q < 5. This study was approved by the ethics committee of our hospital.…”

“…Idiopathic macular hole (IMH) causes vision degradation, central scotoma, and metamorphopsia due to a full-thickness defect of the neuroretina in the macular foveal area [5]. IMH can be treated by vitrectomy surgery [5][6][7].…”

“…Idiopathic macular hole (IMH) causes vision degradation, central scotoma, and metamorphopsia due to a full-thickness defect of the neuroretina in the macular foveal area [5]. IMH can be treated by vitrectomy surgery [5][6][7]. Surgical techniques include removing the vitreous with or without simultaneous peeling of the internal limiting membrane (ILM), uid-air exchange, and gas tamponade [8,9].…”