Idiopathic macular hole - epidemiology, classification, natural course, and therapy

Overview

Idiopathic macular hole is a relatively frequent event affecting the macular area of the retina. It occurs foremost in elderly females. Prevalence is the greatest in the sixties and seventies of life. The ratio of females to males suffering this affection is three to one. The incidence of this disease is one in 3300 patients at an average. In the initial stages of the disease the idiopathic macular hole is not developed in full depth, and that is called imminent hole. In about half of the patients there comes about a spontaneous regression at the stage of an imminent hole. In the other half the idiopathic macular hole progresses to fenestration in full depth of the retina. In question is mostly a unilateral affection, the risk of development of a macular hole in the other eye is less than 2% when the rear vitreous membrane is ablated. The basic symptoms by which the disease is manifested aedecreased central visual acuity and metamorphopsia (image deformation). Even in the terminal stages of the disease the patients are not threatened by total blindness in the affected eye as long as there is no other pathology present. The method of choice in the treatment of the idiopathic macular hole is pars plana vitrectomy with removal of the posterior hyaloid membrane and with intraocular expansive gas tamponade. With this therapeutic procedure there can be attained a closure of the idiopathic macular hole in more than 90% of the patients.

Key words:
idiopathic macular hole - pas plana vitrectomy - peeling of internal limiting membrane