Three-dimenional obervation of developing macular hole

PURPOE: To decribe the morphologic feature of idiopathic macular hole and vitreou traction during macular hole evolution. METHOD: We propectively examined 89 eye of 82 patient with idiopathic macular hole (tage 1, 15 eye; tage 2, 16 eye; tage 3, 50 eye; tage 4, eight eye) uing optical coherence tomography. In addition to optical coherence tomography, canning laer ophthalmocopy wa performed in all 15 eye with tage 1 hole, ix of 16 eye with tage 2, and 19 of 50 eye with tage 3. REULT: In tage 1 eye, optical coherence tomography revealed retinal plit or cytic change at the fovea in 11 of 15 eye (73%) and foveal retinal detachment in four eye (27%). Two eye with foveal cyt progreed to tage 2, and one developed a tage 3 hole. In one eye with retinal detachment, the detached retina thinned and developed dehicence. Optical coherence tomography howed a vitreou cortex that wa detached in the perifoveal area but attached on the fovea in 11 of the 15 tage 1 eye. In tage 2 macular hole, retinal tiue extending from the perifoveal retina formed a flap. canning laer ophthalmocopy demontrated intraretinal radiating triae, which correponded to a foveal cyt or perifoveal cytic change. CONCLUION: Macular hole tart a retinal plit or foveal cyt in mot cae. The anterior wall of the cyt erve a a flap in tage 2 and an operculum in tage 3 hole. Radiating triae correpond to retinal plit or cyt and preumably repreent an elevation of Henle fiber. In a few macular hole, foveal detachment i the initial change. The detached retina thin and eventually develop a hole. In both coure, anterior traction of the lightly detached vitreou cortex appear to be a major contributing factor to macular hole formation