Introduction
Represents the succeeding phases of the vitreomacular interface diseases that are not normal age-related changes, in which holes and tears begin to form in the macular, ultimately progressing to a FTMH.
Dead Giveaways
Lamellar Macular
Diagnostic Triad:
Irregular foveal contour
Foveal cavity with undermined edges (appears as a little cave inside the hole)
Sign evoking a loss of retinal tissue (thinning around the fovea and pseudo-operculums)
They can also be associated with epiretinal proliferation (iso-reflective growth above the ILM), as well as foveal bumps and ellipsoid line disruption
Yellow = pseudo-operculum. Green = foveal bump. Red = epiretinal proliferation. Blue = undermined surface. Orange = region of EZ disruption.
Full Thickness Macular Hole (FTMH)
Diagnostic Triad:
Interruption of all retinal layers, ILM to RPE.
The smallest and narrowest portion of the hole is classified as either small (<250 microns), medium (between 250 and 400 microns) and large (>400 microns).
Watzke-Allen Test. When a faint thing optic section is shone onto the patient's eye, they will report a break in the middle. If it is a pseudohole, a coherent beam will be observed as the photoreceptors are still functioning. Fellow eye should be occluded
Holes typically have rounded edges and can have adjacent pseudocysts. On fundus, appears as round lesions
Image 1 and 3 both show true operculums. Image 2 is a small FTMH with pseudocysts.
Macular Microhole/Solar Retinopathy
Focal discontinuation of the RPE, EZ and/or ELM
On the fundus, appears as a small reddish lesion.
Thought to be related to abnormal VMT
Can resolve spontaneously, or stay stationary overtime. It's aetiology and pathogenesis has not been established.
Solar retinopathy presents bilaterally instead of unilaterally (macular microhole), and has central scotomas, metamorphopsia, dyschromatopsia, micropsia and headaches
Microhole
diagnostic features
FTMH Prognosis:
Those with FTMH have a 10-15% chance of developing it in 2nd eye within 15 years
Patients with FTMH in 1 eye and vitreomacular adhesions in the other eye is considered to have an impending macular hole.
Appearance:
Most holes will appear with a red well defined circular region in the macula on fundus photography.
This is not to be confused with the cherry fundus appearance on CRAO, which is also accompanied by a very white fundus.