This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Its Early Stages and Pathogenesis

J. Donald M. Gass, MD

Arch Ophthalmol. 1988;106(5):629-639.

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.

Author Affiliations
From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine.

Footnotes
Accepted for publication Jan 12, 1988.

Presented at the Macula Society Meeting, Cannes, France, June 25, 1987.

Reprint requests to Bascom Palmer Eye Institute, PO Box 016880, Miami, FL 33101 (Dr Gass).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Quantification of Metamorphopsia in Patients with Macular Hole
Kroyer et al.
IOVS 2008;49:3741-3746.
ABSTRACT | FULL TEXT  

An in vivo evaluation of Brilliant Blue G in animals and humans
Remy et al.
Br. J. Ophthalmol. 2008;92:1142-1147.
ABSTRACT | FULL TEXT  

Safety and Efficacy of Gene Transfer for Leber's Congenital Amaurosis
Maguire et al.
NEJM 2008;358:2240-2248.
ABSTRACT | FULL TEXT  

Macular Hole Formation Without Vitreofoveal Traction
Smiddy
Arch Ophthalmol 2008;126:737-738.
FULL TEXT  

Diagnosis of macular pseudoholes and lamellar macular holes: is optical coherence tomography the "gold standard"?
Bottoni et al.
Br. J. Ophthalmol. 2008;92:635-639.
ABSTRACT | FULL TEXT  

Incidence of retinal detachment after macular surgery: a retrospective study of 634 cases
Guillaubey et al.
Br. J. Ophthalmol. 2007;91:1327-1330.
ABSTRACT | FULL TEXT  

The 100 Most Frequently Cited Articles in Ophthalmology Journals
Ohba et al.
Arch Ophthalmol 2007;125:952-960.
ABSTRACT | FULL TEXT  

Cellular Migration Associated With Macular Hole: A New Method for Comprehensive Bird's-Eye Analysis of the Internal Limiting Membrane
Hisatomi et al.
Arch Ophthalmol 2006;124:1005-1011.
ABSTRACT | FULL TEXT  

Ultrahigh-resolution optical coherence tomography of surgically closed macular holes.
Ko et al.
Arch Ophthalmol 2006;124:827-836.
ABSTRACT | FULL TEXT  

The macular hole: histopathologic studies.
Green
Arch Ophthalmol 2006;124:317-321.
ABSTRACT | FULL TEXT  

Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia
Arevalo et al.
Br. J. Ophthalmol. 2005;89:1423-1426.
ABSTRACT | FULL TEXT  

Macular pigment levels following successful macular hole surgery
Neelam et al.
Br. J. Ophthalmol. 2005;89:1105-1108.
ABSTRACT | FULL TEXT  

Surgery for Idiopathic Full-Thickness Macular Hole: Two-Year Results of a Randomized Clinical Trial Comparing Natural History, Vitrectomy, and Vitrectomy Plus Autologous Serum: Moorfields Macular Hole Study Group Report No. 1
Ezra and Gregor
Arch Ophthalmol 2004;122:224-236.
ABSTRACT | FULL TEXT  

Proteome Analysis of Human Vitreous Proteins
Yamane et al.
Mol. Cell. Proteomics 2003;2:1177-1187.
ABSTRACT | FULL TEXT  

Macular Hole and Macular Detachment in Severe Hypertensive Retinochoroidopathy
Khairallah et al.
Arch Ophthalmol 2003;121:1504-1505.
FULL TEXT  

Disease laterality, eye dominance, and visual handicap in patients with unilateral full thickness macular holes
Waheed and Laidlaw
Br. J. Ophthalmol. 2003;87:626-628.
ABSTRACT | FULL TEXT  

Retinal Damage from Indocyanine Green in Experimental Macular Surgery
Gandorfer et al.
IOVS 2003;44:316-323.
ABSTRACT | FULL TEXT  

Macular hole and myopic refraction
Kobayashi et al.
Br. J. Ophthalmol. 2002;86:1269-1273.
ABSTRACT | FULL TEXT  

Macular hole size as a prognostic factor in macular hole surgery
Ullrich et al.
Br. J. Ophthalmol. 2002;86:390-393.
ABSTRACT | FULL TEXT  

Anatomical Outcomes of Surgery for Idiopathic Macular Hole as Determined by Optical Coherence Tomography
Ip et al.
Arch Ophthalmol 2002;120:29-35.
ABSTRACT | FULL TEXT  

Optical coherence tomography of the vitreoretinal interface in macular hole formation
Tanner et al.
Br. J. Ophthalmol. 2001;85:1092-1097.
ABSTRACT | FULL TEXT  

Peripheral visual field defects after macular hole surgery: a complication with decreasing incidence
Gass et al.
Br. J. Ophthalmol. 2001;85:549-551.
ABSTRACT | FULL TEXT  

Perifoveal Vitreous Detachment Is the Primary Pathogenic Event in Idiopathic Macular Hole Formation
Johnson et al.
Arch Ophthalmol 2001;119:215-222.
ABSTRACT | FULL TEXT  

Immunocytochemical Characterization of Macular Hole Opercula
Ezra et al.
Arch Ophthalmol 2001;119:223-231.
ABSTRACT | FULL TEXT  

Paracentral scotomata: a new finding after vitrectomy for idiopathic macular hole
Haritoglou et al.
Br. J. Ophthalmol. 2001;85:231-233.
ABSTRACT | FULL TEXT  

Idiopathic full thickness macular hole: natural history and pathogenesis
EZRA
Br. J. Ophthalmol. 2001;85:102-109.
FULL TEXT  

Watzke-Allen Slit Beam Test in Macular Holes Confirmed by Optical Coherence Tomography
Tanner and Williamson
Arch Ophthalmol 2000;118:1059-1063.
ABSTRACT | FULL TEXT  

Prevention of visual field defects after macular hole surgery
Cullinane and Cleary
Br. J. Ophthalmol. 2000;84:372-377.
ABSTRACT | FULL TEXT  

Scanning Laser Ophthalmoscope Correlations With Biomicroscopic Findings and Foveal Function After Macular Hole Closure
Hikichi et al.
Arch Ophthalmol 2000;118:193-197.
ABSTRACT | FULL TEXT  

Papillofoveal Traction in Macular Hole Formation: The Role of Optical Coherence Tomography
Chauhan et al.
Arch Ophthalmol 2000;118:32-38.
ABSTRACT | FULL TEXT  

The Visual Performance and Metamorphopsia of Patients With Macular Holes
Saito et al.
Arch Ophthalmol 2000;118:41-46.
ABSTRACT | FULL TEXT  

Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole
Chang et al.
Br. J. Ophthalmol. 1999;83:944-948.
ABSTRACT | FULL TEXT  

Macular Hole Formation: New Data Provided by Optical Coherence Tomography
Gaudric et al.
Arch Ophthalmol 1999;117:744-751.
ABSTRACT | FULL TEXT  

Macular hole following YAG capsulotomy
CHAUDHARY et al.
Br. J. Ophthalmol. 1999;83:753c-753.
FULL TEXT  

Histopathological Features of Vitreous Removed at Macular Hole Surgery
Sadda et al.
Arch Ophthalmol 1999;117:478-484.
ABSTRACT | FULL TEXT  

Assessment of macular function by multifocal electroretinogram before and after macular hole surgery
Si et al.
Br. J. Ophthalmol. 1999;83:420-424.
ABSTRACT | FULL TEXT  

Clinical Course of Macular Holes: The Eye Disease Case-Control Study
Chew et al.
Arch Ophthalmol 1999;117:242-246.
ABSTRACT | FULL TEXT  

Macular Hole: A Continuing Saga
Fine
Arch Ophthalmol 1999;117:248-249.
FULL TEXT  

Objective Assessment of Photoreceptor Displacement and Metamorphopsia: A Study of Macular Holes
Jensen and Larsen
Arch Ophthalmol 1998;116:1303-1306.
ABSTRACT | FULL TEXT  

Macular Hole Opercula: Ultrastructural Features and Clinicopathologic Correlation
Gass et al.
Arch Ophthalmol 1998;116:965-966.
FULL TEXT  

Spontaneous Resolution of Retinal Detachment Occurring After Macular Hole Surgery
Akduman et al.
Arch Ophthalmol 1998;116:465-467.
ABSTRACT | FULL TEXT  

Fundus autofluorescence in patients with macular holes imaged with a laser scanning ophthalmoscope
von Rückmann et al.
Br. J. Ophthalmol. 1998;82:346-351.
ABSTRACT | FULL TEXT  

Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2
Minihan et al.
Br. J. Ophthalmol. 1997;81:1073-1079.
ABSTRACT | FULL TEXT  

Macular Hole Opercula: Ultrastructural Features and Clinicopathological Correlation
Ezra et al.
Arch Ophthalmol 1997;115:1381-1387.
ABSTRACT  

Membranectomy and Autologous Serum for the Retreatment of Full-Thickness Macular Holes
Ezra et al.
Arch Ophthalmol 1997;115:1276-1280.
ABSTRACT  

Formation and Treatment of a Traumatic Macular Hole
Madreperla and Benetz
Arch Ophthalmol 1997;115:1210-1211.
 

Late reopening of successfully treated macular holes
Paques et al.
Br. J. Ophthalmol. 1997;81:658-662.
ABSTRACT | FULL TEXT  

Variations of posterior vitreous detachment
Kakehashi et al.
Br. J. Ophthalmol. 1997;81:527-532.
ABSTRACT | FULL TEXT  

Macular holes viewed objectively
GREGOR
Br. J. Ophthalmol. 1997;81:98-99.
FULL TEXT  

Objective morphological assessment of macular hole surgery by scanning laser tomography
Hudson et al.
Br. J. Ophthalmol. 1997;81:107-116.
ABSTRACT | FULL TEXT  

Differentiating full thickness macular holes from impending macular holes and macular pseudoholes
Tsujikawa et al.
Br. J. Ophthalmol. 1997;81:117-122.
ABSTRACT | FULL TEXT  

Vitrectomy for the Treatment of Full-Thickness Stage 3 or 4 Macular Holes: Results of a Multicentered Randomized Clinical Trial
Freeman et al.
Arch Ophthalmol 1997;115:11-21.
ABSTRACT  

Illustration of the Stages of Idiopathic Macular Holes by Laser Biomicroscopy
Kiryu et al.
Arch Ophthalmol 1995;113:1156-1160.
ABSTRACT  

Bilateral Macular Holes in von Hippel-Lindau Disease
Loewenstein
Arch Ophthalmol 1995;113:143-144.
ABSTRACT  

Results of Surgical Treatment of Recent-Onset Full-Thickness Idiopathic Macular Holes
Ryan and Gilbert
Arch Ophthalmol 1994;112:1545-1553.
ABSTRACT  

Observation of Idiopathic Full-thickness Macular Holes: Follow-up Observation
Yuzawa et al.
Arch Ophthalmol 1994;112:1051-1056.
ABSTRACT  

Macular Hole Following Severe Hypertensive Retinopathy
Cohen and Gass
Arch Ophthalmol 1994;112:878-879.
ABSTRACT  

Pars Plana Vitrectomy for Treatment of Stage 2 Macular Holes
Ruby et al.
Arch Ophthalmol 1994;112:359-364.
ABSTRACT  

Atypical Presentations of Macular Holes
Smiddy
Arch Ophthalmol 1993;111:626-631.
ABSTRACT  

Observations on Patients With Idiopathic Macular Holes and Cysts
Guyer et al.
Arch Ophthalmol 1992;110:1264-1268.
ABSTRACT  

Immunocytochemical Labeling of Cells in Cortical Vitreous From Patients With Premacular Hole Lesions
Campochiaro et al.
Arch Ophthalmol 1992;110:371-377.
ABSTRACT  

Improved Visualization of Macular Hole Lesions With Laser Biomicroscopy
Ogura et al.
Arch Ophthalmol 1991;109:957-961.
ABSTRACT  

Vitreous Surgery for Idiopathic Macular Holes: Results of a Pilot Study
Kelly and Wendel
Arch Ophthalmol 1991;109:654-659.
ABSTRACT  

Risk of Developing Macular Hole
Gass
Arch Ophthalmol 1991;109:610-611.
ABSTRACT  

Early Stages of Macular Holes: To Treat or Not to Treat
de Bustros
Arch Ophthalmol 1990;108:1085-1086.
ABSTRACT  

Risk of Developing a Macular Hole
Akiba et al.
Arch Ophthalmol 1990;108:1088-1090.
ABSTRACT  

Posterior Precortical Vitreous Pocket
Kishi and Shimizu
Arch Ophthalmol 1990;108:979-982.
ABSTRACT