Idiopathic macular hole – literature review Review article
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Published:
Jun 12, 2024
Keywords:
natural history, genesis theory, classification, treatment, full-thickness MH
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Abstract
Full-thickness idiopathic macular hole (MH) is a common cause of visual loss, affecting 3 per 1000 people. It usually affects females in their sixth to eighth decades of life. Best Visual Acuity decreases to less than 0.5. A typical MH’s symptom is the pincushion metamorphopsia, where the shape of an observed object is enrolled inwards and lines are bowed towards the center, in the direction of the fixation point. Over the years many theories of MH formation have been revealed. A recently approved theory states that vitreomacular adhesion with focal contraction of the perifoveal cheloid and pathologic traction can lead to a loss of full-thickness central retina causing a MH. The most valuable diagnostic procedure for MH is optical coherence tomography. Among other useful examinations are fluorescein angiography and angio-OCT. Classification of the stages of development of MH is done with an anatomical Gass classification and the recent The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and MH. Natural history of the MH differs in the early and advanced stages. Pharmacological vitreolysis with ocriplasmin is used in the treatment of the disease. The most effective therapy is the posterior pars plana vitrectomy. Dye and peeling of the internal limiting membrane helps to achieve the closure of the MH and the good visual acuity.
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Niedzielska-Krycia A, Krycia K, Dereń-Szumełda J, Górska A, Sirek S, Wyględowska-Promieńska D. Idiopathic macular hole – literature review. Ophthatherapy [Internet]. 2024Jun.12 [cited 2024Dec.21];11(2):119-26. Available from: https://journalsmededu.pl/index.php/ophthatherapy/article/view/2933
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Diagnostics
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References
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5. Group TEDC-CS. Risk factors for idiopatic macular holes. Am J Opthalmol. 1994; 118: 754-61.
6. Inokuchi N, Ikeda T, Nakamura K et al. Vitreous estrogen levels in patients with an idiopathic macular hole. Clin Ophthalmol. 2015; 9: 549-552.
7. Spaeth GL. Chirurgia okulistyczna. Elsevier Urban & Partner, Wrocław 2006: 747-58.
8. Aaberg TM, Blair CJ, Gass JDM. Macular holes. Am J Ophthalmol. 1970; 69: 555-62.
9. Patel AC, Wendel RT. Vitrectomy for Macular Hole. Seminars in Opthalmology. 1994; 9: 47-55.
10. Ho AC, Lee HC. Macular Hole. Survey of Opthalmology. 1998; Chapter 21.
11. Croll LJ, Croll M. Hole in the macula. Am J Ophthalmol. 1950; 33: 248-53.
12. Kornzweig AL, Feldstein M. Studies of the eye in old age II. Hole in the Macula: a clinico-pathologic study. Am J Ophthalmol. 1950; 33: 243-7.
13. Lister W. Holes in the retina and their clinical significance. Br J Ophthalmol. 1924; 8(1): i4-20.
14. Morgan CM, Schatz H. Idiopatic macular holes. Am J Ophthalmol. 1985; 99: 437-44.
15. Morgan CM, Schatz H. Involutional macular thinnig. A premacular hole conditio. Opthalmology. 1986; 93: 153-61.
16. Gass JDM. Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophtalmol. 1995; 119: 752-9.
17. Chan A, Duker JS, Schumann JS et al. Stage 0 macular holes: observation by optical coherence tomography. Opthalmology. 2004; 111: 2027-32.
18. Theodossiadis G, Petrou P, Eleftheriadou M et al. Focal vitreomacular traction: a prospective study of the evolution to macular hole: the matematical approach. Eye. 2014; 28: 1452-60.
19. La Cour M, Friis J. Macular holes: classification, epidemiology, natural history and treatment. Acta Opthalmologica Scand. 2002; 80: 579-87.
20. Duker JS, Kaiser PK, Binder S et al. The International Vitreomacular Traction Study group Classification of Vitreomacular Adhesion, Traction, and Macular Hole. Opthalmology. 2013; 120(12): 2611-9.
21. De Bustros S. Vitrectomy for prevention of macular holes. Results of a randomized multicentre clinical trial. Vitrectomy for Prevention of Macular Hole Study Group. Ophthalmol. 1994; 101: 1055-9.
22. Kokame GT, De Bustros S. Visual acuity as a prognostic indicator in stage I macular holes. Vitrectomy for Prevention of Macular Hole Study Group. Am J Ophthalmol. 1995; 120: 112-4.
23. Kakehashi A, Schepens CL, Akiba J et al. Spontaneous resolution of foveal detachments and macular breaks. Am J Ophthalmol. 1995; 120: 767-75.
24. Hikichi T, Yoshida A, Akiba J et al. Natural outcomes of stage 1, 2, 3 and 4 idiopathic macular holes. Br J Ophthalmol. 1995; 79: 517-20.
25. Hikichi T, Yoshida A, Akiba J et al. Prognosis of stage 2 macular holes. Am J Ophthalmol. 1995; 119: 571-5.
26. Casuso LA, Scott IU, Flynn HW Jr et al. Long-term, follow-up of unoperated macular holes. Opthalmology. 2001; 108: 1150-5.
27. Guyer DR, De Bustros S, Diener WM et al. Observations on patients with idiopatic macular holes and cysts. Arch Opthalmol. 1992; 110: 1264.
28. Freeman WR, Azen SP, Kim JW et al. Vitrectomy for the treatment of full thickness stage 3 or 4 macular holes. Results of multicentred randomized clinical trial. Vitrectomy for Macular Hole Study Group. Arch Opthalmol. 1997; 115: 11-21.
29. Otsuji F, Uemura A, Nakano T et al. Long-Term Observation of the Vitreomacular Relationship in Normal Fellow Eyes of Patients with Unilateral Idiopathic Macular Holes. Ophthalmologica. 2014; 232: 188-93.
30. Ezra JE, Wells A, Gray RH et al. Incidence of idiopathic full-thickness macular holes in fellow eyes: A 5-year prospective natural history study. Ophthalmology. 1998; 105(2): 353-9.
31. Akiba J, Kakehashi A, Arzabe CW et al. Fellow eyes in idiopathic macular hole cases. Ophthalmic Surg. 1992; 23(9): 594-7.
32. Ezra E. Idiopathic full thickness macular hole: natural history and pathogenesis. Brit J Ophthalmol. 2001; 85: 102-9.
33. Oh J, Smiddy WE, Flynn HW Jr et al. Photoreceptor Inner/Outer Segment Defect Imaging by Spectral Domain OCT and Visual Prognosis after Macular Hole Surgery. Investigative Ophthalmology & Visual Science. 2010; 51: 1651-8.
34. Teng Y, Yu M, Wang Y et al. OCT angiography quantifying choriocapillary circulation in idiopathic macular hole before and after surgery. Graefes Arch Clin Exp Ophthalmol. 2017; 255: 893.
35. Nema HV, Nema N. Macular hole in recent advances in ophthalmology. Jaypee Brothers Medical Publishers, 2013: 200-24.
36. Gonvers M, Machemer R. A New Approach to Treating Retinal Detachment with Macular Hole. Am J Ophthalmol. 1982; 94: 468-72.
37. Kelly E, Wendel R. Vitreous Surgery for Idiopathic Macular Holes Results of a Pilot Study. Arch Ophthalmol. 1991; 109(5): 654-9.
38. Michalewska Z, Michalewski J, Adelman R et al. Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes. Opthalmology. 2010; 117(10): 2018-25.
39. Rang CS, Won KJ, Hoon JJ et al. The Efficacy of Superior Inverted Internal Limiting Membrane Flap Technique for the Treatment of Full-Thickness Macular Hole. Retina 2018; 38(1): 192-7.
40. Michalewska Z, Michalewski J, Dulczewska-Cichecka K et al. Temporal Inverted Internal Limiting Membrane Flap Technique Versus Classic Inverted Internal Limiting Membrane Flap Technique: a Comparative Study. Retina. 2015; 35(9): 1844-50.
41. Engelmann K, Sievert U, Hölig K et al. Effect of autologous platelet concentrates on the anatomical and functional outcome of late stage macular hole surgery: A retrospective analysis. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2015; 58(11-12): 1289-98.
42. Figueroa MS, Govetto A , de Arriba-Palomero P. Short-Term Results of Platelet-Rich Plasma as Adjuvant to 23-G Vitrectomy in the Treatment of High Myopic Macular Holes. Eur J Ophthalmol. 2016; 26(5): 491-6.
43. Blumenkranz MS, Ohana E, Shaikh S et al. Adjuvant Methods in Macular Hole Surgery: Intraoperative Plasma-Thrombin Mixture and Postoperative Fluid-Gas Exchange. Ophthalmic Surgery, Lasers and Imaging Retina. 2001; 32(3): 198-207.
44. Purtskhvanidze K, Frühsorger B, Bartsch S et al. Persistent Full-Thickness Idiopathic Macular Hole: Anatomical and Functional Outcome of Revitrectomy with Autologous Platelet Concentrate or Autologous Whole Blood. Ophthalmologica. 2018; 239: 19-26.
45. Thompson JT, Smiddy WE, Williams GA et al. Comparison of recombinant transforming growth factor-beta-2 and placebo as an adjunctive agent for macular hole surgery. Opthalmology. 1998; 105(4): 700-6.
46. Minihan M, Goggin M, Cleary PE. Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor β2. Brit J Ophthalmol. 1997; 81: 1073-9.
47. Banker AS, Freeman WR, Azen SP et al. A Multicentered Clinical Study of Serum as Adjuvant Therapy for Surgical Treatment of Macular Holes. Arch Ophthalmol. 1999; 117(11): 1499-502.
48. Ezra E, Gregor ZJ. Moorfields Macular Hole Study Group. Surgery for Idiopathic Full-Thickness Macular Hole Two-Year Results of a Randomized Clinical Trial Comparing NaturalHistory, Vitrectomy, and Vitrectomy Plus Autologous Serum: Moorfields MacularHole Study Group Report No. 1. Arch Ophthalmol. 2004; 122(2): 224-36.
49. Zhao X, Ma W, Lian P et al. Three-year outcomes of macular buckling for macular holes and foveoschisis in highly myopic eyes. Acta Ophthalmol. 2020; 98(4): e470-8.
50. Caporossi T, Pacini B, De Angelis L et al. Human amniotic membrane to close recurrent, high myopic macular holes in pathologic myopia with axial length of ≥30 mm. Retina. 2020; 40(10): 1946-54.
51. Hu Z, Xie P, Ding Y et al. Face-down or no face-down posturing following macular hole surgery: a meta-analysis. Acta Ophthalmol. 2016; 94(4): 326-33.
52. Flaxel CJ, Adelman RA, Bailey ST et al. Idiopathic Macular Hole Preferred Practice Pattern. Ophthalmology. 2020; 127(2): P184-P222.
53. EVRS MH Study 2013. Online.
54. Chan CK, Mein CE, Crosson JN. Pneumatic vitreolysis for management of symptomatic focal vitreomacular traction. J Ophthalmic Vis Res. 2017; 12(4): 419-23.
55. Chatziralli I, Theodossiadis G, Xanthopoulou P et al. Ocriplasmin use for vitreomacular traction and macular hole: A meta-analysis and comprehensive review on predictive factors for vitreous release and potential complications. Graefes Arch Clin Exp Ophthalmol. 2016; 254: 1247-56.
2. Pojda SM. Okulistyka w kropelce czyli wiadomości z diagnostyki i udzielania pomocy lekarskiej w chorobach oczu dla lekarzy i studentów medycyny, ŚAM, Katowice 2006: 27-9.
3. Bowling B. Kanski Okulistyka kliniczna. Elsevier Urban & Partner, Wrocław 2017: 618-21.
4. Pecold K (ed). Siatkówka i ciało szkliste, BASICS 12. Elsevier Urban &Partner, Wrocław 2007: 96-9.
5. Group TEDC-CS. Risk factors for idiopatic macular holes. Am J Opthalmol. 1994; 118: 754-61.
6. Inokuchi N, Ikeda T, Nakamura K et al. Vitreous estrogen levels in patients with an idiopathic macular hole. Clin Ophthalmol. 2015; 9: 549-552.
7. Spaeth GL. Chirurgia okulistyczna. Elsevier Urban & Partner, Wrocław 2006: 747-58.
8. Aaberg TM, Blair CJ, Gass JDM. Macular holes. Am J Ophthalmol. 1970; 69: 555-62.
9. Patel AC, Wendel RT. Vitrectomy for Macular Hole. Seminars in Opthalmology. 1994; 9: 47-55.
10. Ho AC, Lee HC. Macular Hole. Survey of Opthalmology. 1998; Chapter 21.
11. Croll LJ, Croll M. Hole in the macula. Am J Ophthalmol. 1950; 33: 248-53.
12. Kornzweig AL, Feldstein M. Studies of the eye in old age II. Hole in the Macula: a clinico-pathologic study. Am J Ophthalmol. 1950; 33: 243-7.
13. Lister W. Holes in the retina and their clinical significance. Br J Ophthalmol. 1924; 8(1): i4-20.
14. Morgan CM, Schatz H. Idiopatic macular holes. Am J Ophthalmol. 1985; 99: 437-44.
15. Morgan CM, Schatz H. Involutional macular thinnig. A premacular hole conditio. Opthalmology. 1986; 93: 153-61.
16. Gass JDM. Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophtalmol. 1995; 119: 752-9.
17. Chan A, Duker JS, Schumann JS et al. Stage 0 macular holes: observation by optical coherence tomography. Opthalmology. 2004; 111: 2027-32.
18. Theodossiadis G, Petrou P, Eleftheriadou M et al. Focal vitreomacular traction: a prospective study of the evolution to macular hole: the matematical approach. Eye. 2014; 28: 1452-60.
19. La Cour M, Friis J. Macular holes: classification, epidemiology, natural history and treatment. Acta Opthalmologica Scand. 2002; 80: 579-87.
20. Duker JS, Kaiser PK, Binder S et al. The International Vitreomacular Traction Study group Classification of Vitreomacular Adhesion, Traction, and Macular Hole. Opthalmology. 2013; 120(12): 2611-9.
21. De Bustros S. Vitrectomy for prevention of macular holes. Results of a randomized multicentre clinical trial. Vitrectomy for Prevention of Macular Hole Study Group. Ophthalmol. 1994; 101: 1055-9.
22. Kokame GT, De Bustros S. Visual acuity as a prognostic indicator in stage I macular holes. Vitrectomy for Prevention of Macular Hole Study Group. Am J Ophthalmol. 1995; 120: 112-4.
23. Kakehashi A, Schepens CL, Akiba J et al. Spontaneous resolution of foveal detachments and macular breaks. Am J Ophthalmol. 1995; 120: 767-75.
24. Hikichi T, Yoshida A, Akiba J et al. Natural outcomes of stage 1, 2, 3 and 4 idiopathic macular holes. Br J Ophthalmol. 1995; 79: 517-20.
25. Hikichi T, Yoshida A, Akiba J et al. Prognosis of stage 2 macular holes. Am J Ophthalmol. 1995; 119: 571-5.
26. Casuso LA, Scott IU, Flynn HW Jr et al. Long-term, follow-up of unoperated macular holes. Opthalmology. 2001; 108: 1150-5.
27. Guyer DR, De Bustros S, Diener WM et al. Observations on patients with idiopatic macular holes and cysts. Arch Opthalmol. 1992; 110: 1264.
28. Freeman WR, Azen SP, Kim JW et al. Vitrectomy for the treatment of full thickness stage 3 or 4 macular holes. Results of multicentred randomized clinical trial. Vitrectomy for Macular Hole Study Group. Arch Opthalmol. 1997; 115: 11-21.
29. Otsuji F, Uemura A, Nakano T et al. Long-Term Observation of the Vitreomacular Relationship in Normal Fellow Eyes of Patients with Unilateral Idiopathic Macular Holes. Ophthalmologica. 2014; 232: 188-93.
30. Ezra JE, Wells A, Gray RH et al. Incidence of idiopathic full-thickness macular holes in fellow eyes: A 5-year prospective natural history study. Ophthalmology. 1998; 105(2): 353-9.
31. Akiba J, Kakehashi A, Arzabe CW et al. Fellow eyes in idiopathic macular hole cases. Ophthalmic Surg. 1992; 23(9): 594-7.
32. Ezra E. Idiopathic full thickness macular hole: natural history and pathogenesis. Brit J Ophthalmol. 2001; 85: 102-9.
33. Oh J, Smiddy WE, Flynn HW Jr et al. Photoreceptor Inner/Outer Segment Defect Imaging by Spectral Domain OCT and Visual Prognosis after Macular Hole Surgery. Investigative Ophthalmology & Visual Science. 2010; 51: 1651-8.
34. Teng Y, Yu M, Wang Y et al. OCT angiography quantifying choriocapillary circulation in idiopathic macular hole before and after surgery. Graefes Arch Clin Exp Ophthalmol. 2017; 255: 893.
35. Nema HV, Nema N. Macular hole in recent advances in ophthalmology. Jaypee Brothers Medical Publishers, 2013: 200-24.
36. Gonvers M, Machemer R. A New Approach to Treating Retinal Detachment with Macular Hole. Am J Ophthalmol. 1982; 94: 468-72.
37. Kelly E, Wendel R. Vitreous Surgery for Idiopathic Macular Holes Results of a Pilot Study. Arch Ophthalmol. 1991; 109(5): 654-9.
38. Michalewska Z, Michalewski J, Adelman R et al. Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes. Opthalmology. 2010; 117(10): 2018-25.
39. Rang CS, Won KJ, Hoon JJ et al. The Efficacy of Superior Inverted Internal Limiting Membrane Flap Technique for the Treatment of Full-Thickness Macular Hole. Retina 2018; 38(1): 192-7.
40. Michalewska Z, Michalewski J, Dulczewska-Cichecka K et al. Temporal Inverted Internal Limiting Membrane Flap Technique Versus Classic Inverted Internal Limiting Membrane Flap Technique: a Comparative Study. Retina. 2015; 35(9): 1844-50.
41. Engelmann K, Sievert U, Hölig K et al. Effect of autologous platelet concentrates on the anatomical and functional outcome of late stage macular hole surgery: A retrospective analysis. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2015; 58(11-12): 1289-98.
42. Figueroa MS, Govetto A , de Arriba-Palomero P. Short-Term Results of Platelet-Rich Plasma as Adjuvant to 23-G Vitrectomy in the Treatment of High Myopic Macular Holes. Eur J Ophthalmol. 2016; 26(5): 491-6.
43. Blumenkranz MS, Ohana E, Shaikh S et al. Adjuvant Methods in Macular Hole Surgery: Intraoperative Plasma-Thrombin Mixture and Postoperative Fluid-Gas Exchange. Ophthalmic Surgery, Lasers and Imaging Retina. 2001; 32(3): 198-207.
44. Purtskhvanidze K, Frühsorger B, Bartsch S et al. Persistent Full-Thickness Idiopathic Macular Hole: Anatomical and Functional Outcome of Revitrectomy with Autologous Platelet Concentrate or Autologous Whole Blood. Ophthalmologica. 2018; 239: 19-26.
45. Thompson JT, Smiddy WE, Williams GA et al. Comparison of recombinant transforming growth factor-beta-2 and placebo as an adjunctive agent for macular hole surgery. Opthalmology. 1998; 105(4): 700-6.
46. Minihan M, Goggin M, Cleary PE. Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor β2. Brit J Ophthalmol. 1997; 81: 1073-9.
47. Banker AS, Freeman WR, Azen SP et al. A Multicentered Clinical Study of Serum as Adjuvant Therapy for Surgical Treatment of Macular Holes. Arch Ophthalmol. 1999; 117(11): 1499-502.
48. Ezra E, Gregor ZJ. Moorfields Macular Hole Study Group. Surgery for Idiopathic Full-Thickness Macular Hole Two-Year Results of a Randomized Clinical Trial Comparing NaturalHistory, Vitrectomy, and Vitrectomy Plus Autologous Serum: Moorfields MacularHole Study Group Report No. 1. Arch Ophthalmol. 2004; 122(2): 224-36.
49. Zhao X, Ma W, Lian P et al. Three-year outcomes of macular buckling for macular holes and foveoschisis in highly myopic eyes. Acta Ophthalmol. 2020; 98(4): e470-8.
50. Caporossi T, Pacini B, De Angelis L et al. Human amniotic membrane to close recurrent, high myopic macular holes in pathologic myopia with axial length of ≥30 mm. Retina. 2020; 40(10): 1946-54.
51. Hu Z, Xie P, Ding Y et al. Face-down or no face-down posturing following macular hole surgery: a meta-analysis. Acta Ophthalmol. 2016; 94(4): 326-33.
52. Flaxel CJ, Adelman RA, Bailey ST et al. Idiopathic Macular Hole Preferred Practice Pattern. Ophthalmology. 2020; 127(2): P184-P222.
53. EVRS MH Study 2013. Online.
54. Chan CK, Mein CE, Crosson JN. Pneumatic vitreolysis for management of symptomatic focal vitreomacular traction. J Ophthalmic Vis Res. 2017; 12(4): 419-23.
55. Chatziralli I, Theodossiadis G, Xanthopoulou P et al. Ocriplasmin use for vitreomacular traction and macular hole: A meta-analysis and comprehensive review on predictive factors for vitreous release and potential complications. Graefes Arch Clin Exp Ophthalmol. 2016; 254: 1247-56.