May 2004
Volume 45, Issue 13
ARVO Annual Meeting Abstract  |   May 2004
Anatomical Similarities between Stage 3 and Stage 4 Macular Holes: Implications for Treatment
Author Affiliations & Notes
  • J. Wender
    New York, NY
  • T. Iida
    Fukushima, Japan
  • L.V. Del Priore
    New York, NY
  • Footnotes
    Commercial Relationships  J. Wender, None; T. Iida, None; L.V. Del Priore, None.
  • Footnotes
    Support  Eye Surgery Fund, Robert L. Burch III Fund, the Macula Foundation, and Research to Prevent Blindness
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 1960. doi:
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      J. Wender, T. Iida, L.V. Del Priore; Anatomical Similarities between Stage 3 and Stage 4 Macular Holes: Implications for Treatment . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1960.

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

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Abstract: : Purpose: To determine whether the observed anatomy of macularholes can be explained by a hydrodynamic model in which fluidflow through the hole is balanced by fluid pumping across theRPE (Figure 1). We use this model to draw conclusions aboutthe role of vitreomacular traction in determining the morphologyof macular holes and their resolution after vitreous surgery.Methods: Retrospective study including 42 eyes of 42 patients,each with a stage 3 or 4 macular hole (Gass classification).Macular holes were staged based on clinical exam, Optical CoherenceTomography, and intraoperative findings. We measured the radiusof the macular hole and the radius of the surrounding cuff ofsubretinal fluid from fundus photographs.Results: The mean age of the patients was 68.0 ± 7 years(range 51–80). 25 patients had stage 3 holes and 17 patientshad stage 4 holes. The neurosensory detachment radius was relatedto the square of the macular hole radius, with no significantdifference between the stage 3 and stage 4 linear trend lines(p=0.999) (Figure 2). The area of the doughnut–shapedcuff of subretinal fluid increased with increasing patient age(p=0.0493), suggesting an age–dependent decline in thepumping ability of the RPE.Conclusions: Our data is consistent with a hydrodynamic modelof macular hole anatomy in which fluid flow through the holeis balanced by the outflow of fluid across the RPE. Since Stage3 and 4 macular holes exhibit a similar relationship betweenthe size of the macular hole and the size of the subretinalfluid cuff around the hole, relief of vitreomacular tractionwould not lead to resolution of the subretinal fluid cuff unlessit is accompanied by a reduction in hole diameter. 


Keywords: macular holes • vitreous • retinal detachment 

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