Macular hole

Definition: Full thickness neurosensory defect at the fovea.

Demographics: Female around 60s.


Causes:

  • Idiopathic / age related
  • Trauma
  • Chronic CMO
  • Laser treatment
  • Retinal vascular disease
  • RD
  • Lightning / Electrocution

Stages (Gass classification)

  • Stage 1A: Impending hole
  • Stage 1B: Occult hole
  • Stage 2: < 400 microns
  • Stage 3: > 400 microns with incomplete PVD
  • Stage 4: > 400 microns with complete PVD

Signs & Symptoms:

  • Variable degree of central visual loss
  • Metamorphosia
  • Watzke-Allen test – positive

Investigations:

  • OCT macula
  • Fundus autofluorescence – prognostic value – hyperautofluorescnece disappears at macular hole that is close indicating RPE is recovering

Management:

  • Early Stage 2 MH and traumatic MH – observe for few weeks – may close spontaneously
  • Otherwise most will need MHS – PPV + ILM peel + gas tamponade +/- face down posturing.
  • Other additional surgical techniques – ILM peeling, use of autologous platelet, silicone oil use, ILM grafts.

Lamellar MH – observation for stable VA (8/10 patients remain stable).


Location Birmingham Midlands Eye Centre 76 Dudley Road Birmingham B18 7QH UK Phone 0121 554 3801 Hours Mr Ch'ng | Vitreoretinal Clinic Sessions: Monday: 8.30am - 12.30pm Wednesday (alternate): 8.30am - 5.00pm Thursday: 8.30am - 12.30pm Friday: 8.30am - 12.30pm | Vitreoretinal Theatre Sessions: Wednesday (alternate): 8.30am - 5.00pm & Friday (emergency cases): 1.30pm - 5.00pm | Eye Casualty Session: Monday 1.00pm - 4.30pm |
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