ABSTRACT
Full-thickness macular holes are defects involving all layers of the retina from the internal limiting membrane through the outer segment of retinal photoreceptors. This chapter reviews the pathogenesis, natural history, and surgical management of idiopathic macular holes. Traumatic macular holes may result from immediate contusive injury to the retina or avulsion of retinal tissue from trauma-induced posterior vitreous detachment. C. M. Morgan and H. Schatz implicated retinal degeneration, or involutional macular thinning, in the pathogenesis of idiopathic macular holes. Important features differentiating true macular holes from ‘pseudoholes’ are a surrounding cuff of subretinal fluid, drusen-like yellowish deposits in the base of the hole, a distinct and circular margin around the hole, and an operculum. N. S. Melberg and M. A. Thomas described the occurrence of visual field defects after pars plana vitrectomy for macular hole surgery. Patients with prominent macular drusen appear to do well both anatomically and visually after macular hole surgery.
