Macular Hole

Question 1

What are the risk factors of a macular hole?

Answer 1

Age, Female Gender, Trauma, Myopia, Ocular Inflammation

Question 2

What is the pathogenesis of a Macular Hole?

Answer 2

1. Tangential traction and posterior veitreoretinal traction of the posterior hyaloid
2. PVD

Question 3

What are the signs of a macular hole for the 4 different stages?

Answer 3

Stage 1 (Snellen 6/9-6/12): No PVD, Absent foveal depression, lipofuscin (yellow spot) 100-200um diam, no hole visible.

Stage 2 (6/12-6/24): Small hole, yellow ring, surrounding ring of neurosensory detachment.

Stage 3 (6.24-6/60): Larger hole >400um diam, surrounding neurosensory detachment, operculum overlying hole, yellow nodular deposits on RPE.

Stage 4 (6/24-6/60): Associated PVD

Question 4

What are the symptoms for a macular hole?

Answer 4

Usually asymptomatic but:
Stage 1: Mild central vision loss, metamorphopsia
Stage 2/3/4: Mod-Sev central vision loss, sometimes a central scotoma

Question 5

What 3 investigations for a macular hole?

Answer 5

Slit lamp, dilated fundus, fundus photography, OCT for size.

Question 6

What would the treatment be for a macular hole?

Answer 6

Surgery: Vitrectomy gas bubble of vitrectomy peeling

Non-Surgical: Ocriplasmin

Question 7

What is the management/referral for a macular hole?

Answer 7

For stage 1 cases continue to monitor as most cases resolve spontaneously

For stage 2 onwards, urgent referral within 2 weeks