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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.
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© ARVO (1962-2015); The Authors (2016-present)
To propose and present evidence for the Combined Tractional-Hydration Theory of Idiopathic Macular Hole Formation, Progression, and Closure.
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.
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.
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.
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