Idiopathic Full-Thickness Macular Holes and the Vitreomacular Interface; A Spectral-Domain Optical Coherence Tomography Study

Abstract

Purpose: : The aim of this study was to analyze the morphologies of the vitreomacular interface in idiopathic full-thickness macular holes (MH) using images prospectively obtained by spectral-domain optical coherence tomography (SD-OCT).

Methods: : Ninety-one eyes of 86 consecutive patients with a MH were examined by SD-OCT in this prospective cross-sectional observational study. We analyzed the initial morphologies of the vitreomacular interface assessed by faint reflectivity of the continuous linear signal in the posterior vitreous as the posterior hyaloid membrane and the presence or absence of an operculum in front of the hole.

Results: : Forty-five eyes had a stage 2 MH, 19 eyes a stage 3 MH, and 27 eyes a stage 4 MH. We did not detect the posterior vitreous membrane in any eyes with a stage 4 MH even in the SD-OCT images. In 35 (54.7%) of the 64 eyes with stage 2 and 3 MHs, we saw a perifoveal posterior vitreous detachment with vitreofoveal adhesion and a partial dehiscence of the inner retina (open roof) with outer retinal separation in the MH. In 24 (37.5%) of the 64 eyes with stage 2 and 3 MHs, we saw an operculum in front of the hole. The posterior hyaloid membrane was separated completely from the posterior retina except at the optic disc margin. In 2 (3.1%) of the 64 eyes with stage 2 and 3 MHs, the plane of the posterior hyaloid membrane was located in the vitreous. However, we didn’t see an operculum. In three (4.7%) of the 64 eyes with stage 2 and 3 MHs, we saw vitreofoveal adhesion connected to the taut posterior hyaloid membrane on both sides of the MH edges in the vertical and horizontal scans.

Conclusions: : Analysis of the vitreomacular interface on SD-OCT showed that only three (4.7%) of 64 eyes in patients with stage 2 and 3 MHs began as dehiscence at the umbo, and progressive centrifugal enlargement of the hole presumably contributed to the tangential vitreous traction of the posterior hyaloid membrane.

Keywords: macular holes • imaging/image analysis: clinical • retina