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Idiopathic Senile Macular Hole: Its Early Stages and Pathogenesis

Idiopathic Senile Macular Hole: Its Early Stages and Pathogenesis Abstract • Evidence is presented that idiopathic senile macular hole is caused by focal shrinkage of the vitreous cortex in the foveal area. The most reliable biomicroscopic signs of impending hole formation (stage 1) are the development of a yellow spot or ring in the center of the fovea, loss of the foveal depression, and no evidence of separation of the vitreous from the foveal retina. Although in a majority of eyes with stage 1 changes there is a progression to hole formation, spontaneous separation of the vitreous without hole formation may occur in some cases (44%) and cause characteristic biomicroscopic changes, including foveal reattachment, disappearance of the yellow spot or ring, and, in some cases, a pseudo-operculum, with one or more lamellar holes or facets. A prospective collaborative study is recommended to confirm these findings and to test the clinical value of surgical peeling of the vitreous cortex in eyes with stage 1 changes as a means of preventing hole formation. References 1. Aaberg TM, Blair CJ, Gass JDM: Macular holes . Am J Ophthalmol 1970;69:555-562. 2. Aaberg TM: Macular holes: A review . Surv Ophthalmol 1970;15:139-162. 3. Avila MP, Jalkh AE, Murakami K, et al: Biomicroscopic study of the vitreous in macular breaks . Ophthalmology 1983;90:1277-1283.Crossref 4. Bronstein MA, Trempe CL, Freeman HM: Fellow eyes of eyes with macular holes . Am J Ophthalmol 1981;92:757-761. 5. Gass JDM: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment . St Louis, CV Mosby Co, 1970, pp 195-199. 6. Gass JDM: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment , ed 3. St Louis, CV Mosby Co, 1987, pp 684-693. 7. James M, Feman SS: Macular holes . Graefes Arch Klin Exp Ophthalmol 1980;215:59-63.Crossref 8. Margherio RR, Schepens CL: Macular breaks: I. Diagnosis, etiology, and observations . Am J Ophthalmol 1972;74:219-232. 9. McDonnell PJ, Fine SL, Hillis AI: Clinical features of idiopathic macular cysts and holes . Am J Ophthalmol 1982;93:777-786. 10. Morgan CM, Schatz H: Idiopathic macular holes . Am J Ophthalmol 1985;99:437-444. 11. Morgan CM, Schatz H: Involutional macular thinning: A pre—macular hole condition . Ophthalmology 1986;93:153-161.Crossref 12. Trempe CL, Weiter JJ, Furukawa H: Fellow eyes in cases of macular hole: Biomicroscopic study of the vitreous . Arch Ophthalmol 1986;104:93-95.Crossref 13. Yaoeda H: Clinical observation on macular hole . Acta Soc Ophthalmol Jpn 1967;71:1723-1736. 14. Reese AB, Jones IS, Cooper WC: Macular changes secondary to vitreous traction . Am J Ophthalmol 1967;64:544-549. 15. Frangieh GT, Green WR, Engel HM: A histopathologic study of macular cysts and holes . Retina 1981;1:311-336.Crossref 16. Kornzweig AL, Feldstein M: Studies of the eye in old age: II. Hole in the macula: A clinicopathologic study . Am J Ophthalmol 1950;33:243-247. 17. Foos RY: Vitreoretinal juncture: Topographical variations . Invest Ophthalmol Vis Sci 1972;11:801-808. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Idiopathic Senile Macular Hole: Its Early Stages and Pathogenesis

Archives of Ophthalmology , Volume 106 (5) – May 1, 1988

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1988.01060130683026
Publisher site
See Article on Publisher Site

Abstract

Abstract • Evidence is presented that idiopathic senile macular hole is caused by focal shrinkage of the vitreous cortex in the foveal area. The most reliable biomicroscopic signs of impending hole formation (stage 1) are the development of a yellow spot or ring in the center of the fovea, loss of the foveal depression, and no evidence of separation of the vitreous from the foveal retina. Although in a majority of eyes with stage 1 changes there is a progression to hole formation, spontaneous separation of the vitreous without hole formation may occur in some cases (44%) and cause characteristic biomicroscopic changes, including foveal reattachment, disappearance of the yellow spot or ring, and, in some cases, a pseudo-operculum, with one or more lamellar holes or facets. A prospective collaborative study is recommended to confirm these findings and to test the clinical value of surgical peeling of the vitreous cortex in eyes with stage 1 changes as a means of preventing hole formation. References 1. Aaberg TM, Blair CJ, Gass JDM: Macular holes . Am J Ophthalmol 1970;69:555-562. 2. Aaberg TM: Macular holes: A review . Surv Ophthalmol 1970;15:139-162. 3. Avila MP, Jalkh AE, Murakami K, et al: Biomicroscopic study of the vitreous in macular breaks . Ophthalmology 1983;90:1277-1283.Crossref 4. Bronstein MA, Trempe CL, Freeman HM: Fellow eyes of eyes with macular holes . Am J Ophthalmol 1981;92:757-761. 5. Gass JDM: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment . St Louis, CV Mosby Co, 1970, pp 195-199. 6. Gass JDM: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment , ed 3. St Louis, CV Mosby Co, 1987, pp 684-693. 7. James M, Feman SS: Macular holes . Graefes Arch Klin Exp Ophthalmol 1980;215:59-63.Crossref 8. Margherio RR, Schepens CL: Macular breaks: I. Diagnosis, etiology, and observations . Am J Ophthalmol 1972;74:219-232. 9. McDonnell PJ, Fine SL, Hillis AI: Clinical features of idiopathic macular cysts and holes . Am J Ophthalmol 1982;93:777-786. 10. Morgan CM, Schatz H: Idiopathic macular holes . Am J Ophthalmol 1985;99:437-444. 11. Morgan CM, Schatz H: Involutional macular thinning: A pre—macular hole condition . Ophthalmology 1986;93:153-161.Crossref 12. Trempe CL, Weiter JJ, Furukawa H: Fellow eyes in cases of macular hole: Biomicroscopic study of the vitreous . Arch Ophthalmol 1986;104:93-95.Crossref 13. Yaoeda H: Clinical observation on macular hole . Acta Soc Ophthalmol Jpn 1967;71:1723-1736. 14. Reese AB, Jones IS, Cooper WC: Macular changes secondary to vitreous traction . Am J Ophthalmol 1967;64:544-549. 15. Frangieh GT, Green WR, Engel HM: A histopathologic study of macular cysts and holes . Retina 1981;1:311-336.Crossref 16. Kornzweig AL, Feldstein M: Studies of the eye in old age: II. Hole in the macula: A clinicopathologic study . Am J Ophthalmol 1950;33:243-247. 17. Foos RY: Vitreoretinal juncture: Topographical variations . Invest Ophthalmol Vis Sci 1972;11:801-808.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: May 1, 1988

References