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M. Takezawa, A. Kakehashi, F. Toyoda, C. Kambara, H. Yamagami; Vitreomacular Relationships in Fellow Eyes of Eyes With an Idiopathic Macular Hole. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1326.
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© ARVO (1962-2015); The Authors (2016-present)
To clarify the natural course of the fellow eyes of those with an idiopathic macular hole (MH) and the pathogenesis of MH by spectral domain optical coherence tomography (SD-OCT).
We observed the fellow eyes of 31 patients (age range, 49-81 years; mean, 66.4years) with an idiopathic full-thickness macular hole and 35 normal eyes without a biomicroscopic posterior vitreous detachment (PVD) (age range, 41-72 years; mean, 68.3years), with the examination focused on the vitreomacular relationship observed by SD-OCT (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA).
Six types of vitreomacular relationships were classified as follows: type 1, no PVD, 5 fellow eyes (16%) of those with a MH and 5 control eyes (14.3%); type 2, shallow PVD with a perifoveal vitreous attachment, 7fellow eyes (23%) of those with a MH and 11 control eyes (31%); type 3, shallow PVD with pinpoint foveal vitreous traction, 7 fellow eyes (14%) of those with a MH and no control eyes (0%); type 4a, shallow PVD with a round defect in the posterior vitreous cortex over the perifoveal area with vitreous attachment to the perifoveal area, 2 fellow eye (6%) of those with a MH and no control eyes (0%); type 4b, shallow PVD with a round defect in the posterior vitreous cortex over the perifoveal area without vitreous attachment to the perifoveal area, no fellow eye (0%) of those with a MH and 1 control eyes (3%) type 5a, shallow PVD with no pseudo-operculum, no fellow eyes (0%) of those with a MH and 4 control eyes (11.4%); type 5b, shallow PVD with a pseudo-operculum, 4 fellow eyes (13%) of those with a MH and no control eyes (0%); and type 6, biomicroscopic PVD, 6 fellow eyes (19%) of those with a MH and no control eyes.
Types 3,4a and 5b were observed only in the fellow eyes of those with a MH and not in controls. Vitreofoveal adhesion seems to be the basic pathogenesis of MHs. Intrusion of liquefied vitreous into the subhyaloid must exert vitreous traction on the fovea and be instrumental in the development of a MH. Type 3 carries a high risk and type 5b carries a low risk of developing a MH. Observing vitreomacular relationships by SD-OCT seems to be useful for determining the prognosis in MH cases.
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