June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
The Combined Tractional-Hydration Theory of Idiopathic Macular Holes
Author Affiliations & Notes
  • Ronald C Gentile
    Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY
    Ophthalmology, Winthrop University Hospital, Mineola, NY
  • Dean Eliott
    Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
  • Richard B Rosen
    Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY
  • Joseph Benevento
    Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY
  • Vincent S Reppucci
    Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY
  • Raymond Iezzi
    Department of Ophthalmology, Mayo Clinic School of Medicine, Rochester, MN
  • Footnotes
    Commercial Relationships Ronald Gentile, Alcon surgical (C); Dean Eliott, Acucela (C), Advanced Cell Technology (F), Alimera (C), Arctic (C), Avalanche (C), Bausch & Lomb (C), Biogen (C), Thrombogenics (C); Richard Rosen, Advanced Cell Technologies (E), Allergan (C), Clarity (C), OD-OS (C), Optovue (C); Joseph Benevento, None; Vincent Reppucci, None; Raymond Iezzi, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 4325. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Ronald C Gentile, Dean Eliott, Richard B Rosen, Joseph Benevento, Vincent S Reppucci, Raymond Iezzi; The Combined Tractional-Hydration Theory of Idiopathic Macular Holes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4325.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose: To propose and present evidence for the Combined Tractional-Hydration Theory of Idiopathic Macular Hole Formation, Progression, and Closure.

Methods: Serial OCT images along with clinical examination data of over a 100 eyes with idiopathic macular holes over a fifteen year period were studied. Particular attention was given to evaluating changes over time especially in eyes that had multiple OCT images before a full thickness macular hole formed and/or shortly after surgical repair or spontaneous closure of the hole occurred.

Results: Dynamic interpretation of OCT images suggest that the pathophysiology of idiopathic macular holes can be divided into three distinct phases and one pivotal event. The 1st Phase or Initiating Phase includes anterior-posterior traction on the surface of the foveola as the cortical vitreous separates from it. If the 1st Phase leads to the Pivotal Event, a break in both the ILM and ELM within the foveal pit, the macular hole may enter the 2nd Phase or Progression Phase to become a full thickness macular hole. If the 2nd Phase does not occur, the macular hole can be considered aborted. Rarely eyes can have delayed involvement of the ELM as a result of tangential traction after complete vitreous detachment. The Progression Phase (2nd Phase) results in cystoid hydration and thickening of the foveola with or without evidence of further vitreofoveal traction. During cystoid hydration, the macular hole enlarges as the edges of the hole become elevated from the retinal pigment epithelium with an increase in sub-retinal fluid. The 3rd Phase, or Closure Phase, most often occurs surgically, but can occasionally occur spontaneously and in some cases can be medically prompted to close. The Closure Phase starts with resolution of the cystoid hydration also called cystoid dehydration with closure of the hole followed by subsequent reabsorption of the sub-retinal fluid/subfoveal lucency.

Conclusions: Dynamic evaluations of multiple OCT images supports the Combined Tractional-Hydration Theory of Idiopathic Macular Hole Formation, Progression, and Closure with three distinct phases and one pivotal event.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×