Surgical Management of Macular Hole at 2 Years of Follow-Up

Idiopathic macular holes (MHs) are anatomic defects at the neurosensory central retina extending from the internal limiting layer (ILM) to the retinal pigment epithelium. The physiopathology ofMHs is related to anomalous vitreomacular adhesion in primary MHs. Secondary MHs are rarer and usually related to trauma, laser, or intraocular surgeries. MHs are a significant cause of visual impairment especially in older patients, in whom they develop more frequently. MHs are suspected when patients complain of visual impairment, central scotoma or metamorphopsia and confirmed by fundus examination and optical coherence tomography (OCT).

Although the original Gass classification is still used widely in clinical practice, a new classification based on OCT findings was reported recently. This classification considers thepresence or absence of vitreomacular traction (VMT), size, and MH etiology. In this OCT-based anatomic classification system, MHs are defined as small when the minimal width is below 250 μm, medium from 250-400 μm, and large over 400 μm. MHs also are classified as having or not having VMT and as primary or secondary forms.