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Celine Faure, Julien Pérol, Yannick Le Mer, Alain Gaudric, Ramin Tadayoni, José-Alain Sahel, Michel Paques; Foveal Thickness As An Indicator Of Risk For Macular Hole. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4481. doi: https://doi.org/.
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Idiopathic macular hole physiopathology is still incompletely understood, in particular the higher incidence in females. In order to determine if foveal structure contributed to the pathogenesis of macular holes, we examined fellow eyes of patients with idiopathic macular holes.
The charts of 23 patients with idiopathic macular hole were reviewed. High resolution optical coherence tomography images of fellow eyes were analysed with a dedicated software in order to measure central foveal thickness, outer nuclear retinal thickness and inner layers separation. The results were compared to a control group of 57 healthy subjects.
Among the 23 fellow eyes, we observed 2 epiretinal membranes, 2 bilateral macular holes, 1 vitreoretinal traction syndrome and 1 macular oedema. Four had vitreous traction on the fovea suggesting pre-macular hole conditions. In the 13 other eyes, central foveal thickness was significantly thinner (163 µm ± 9 vs 188 µm ± 20; p<0.001) and the separation of the inner retinal layers were significantly higher than in the control group (p<0.001).
It is likely that thinner and wider foveas show less resistance to vitreal traction, because foveolar cones are only held together by Müller cells, whereas astrocytes and perifoveal vessels provide a much stronger scaffolding in the extrafoveal retina. Those structural specificities could favour inner retinal wrenching during perifoveal vitreous detachment. Foveal thinness is hence a major risk factor for macular holes. As the fovea is known to be thinner in females, this could account for the higher rate of macular holes in women population.
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