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Am J Ophthalmol. 1995 Jun;119(6):752-9.

Reappraisal of biomicroscopic classification of stages of development of a macular hole.

Author information

1
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Medical Center, Florida, USA.

Abstract

PURPOSE:

To update the biomicroscopic classification and anatomic interpretations of the stages of development of age-related macular hole and provide explanations for the remarkable recovery of visual acuity that occurs in some patients after vitreous surgery.

METHODS:

Recent biomicroscopic observations of various stages of macular holes are used to postulate new anatomic explanations for these stages.

RESULTS:

Biomicroscopic observations include the following: (1) the change from a yellow spot (stage 1-A) to a yellow ring (stage 1-B) during the early stages of foveal detachment is unique to patients at risk of macular hole; (2) the prehole opacity with a small stage 2 hole may be larger than the hole diameter; and (3) the opacity resembling an operculum that accompanies macular holes is indistinguishable from a pseudo-operculum found in otherwise normal fellow eyes.

CONCLUSIONS:

The change from a yellow spot (stage 1-A) to a yellow ring (stage 1-B) is caused primarily by centrifugal displacement of retinal receptors after a dehiscence at the umbo. The hole may be hidden by semiopaque contracted prefoveolar vitreous cortex bridging the yellow ring (stage 1-B occult hole). Stage 1-B occult holes become manifest (stage 2 holes) either after early separation of the contracted prefoveolar vitreous cortex from the retina surrounding a small hole or as an eccentric can-opener-like tear in the contracted prefoveolar vitreous cortex, at the edge of larger stage 2 holes. Most prehole opacities probably contain no retinal receptors (pseudo-opercula). Surgical reattachment of the retina surrounding the hole and centripetal movement of the foveolar retina induced by gliosis may restore foveal anatomy and function to near normal.

PMID:
7785690
DOI:
10.1016/s0002-9394(14)72781-3
[Indexed for MEDLINE]

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