Macular HoleF.Fazel:MD

Pathophysiology of MH

Trauma Laser treatment Cystoid macular edema Inflammation Retinal vascular disease Retinal detachment Age-related primary

idiopathic

Idiopathic MH

Seven decade Predominantly female(67%-91%) Younger age in myopes 1%-25% bilatera

Pathophysiology

Anteroposterior transvitreal traction????...

Tangential traction of cortical vitreous

Staging

Staging

1:impendiing MH(foveal &foveolar detached)

2:small fullthicknes MH)<400M)3:fullthickness MH(>400M)4:Complete PVD

Signs & symptomsstage 1

Mild Central visual loss &metamorphopsia

Loss of foveal depression Yellow spot or yellow ring 50% resolved spontaneously 50% progress to stage 2

Signs & sympomsstage 2-3

Full thikness hole Vision loss Annular neurosensory detachment Absolute scotoma((watzke-allen

sign)

Sign & symptomsstage4

Complete PVD (weiss ring)

Fluorescein Angiography

Circular transmission defect(stage 2-3-4)

Loss of xanthophyll & RPE atrophy

OCT

IS GOLD STANDARD IN DIAGNOSIS AND STAGING

Stage 1

Stage 2

Stage 3

Stage 4

Management

Stage 1:fallow up Stage 2-4:vitrectomy +gas

injection(90%-100% hole closure)