Vitreoretinal tomography and foveolar traction in macular hole development and macular pseudohole

Objective: To clarify the morphologic features and foveolar traction in macular hole development and macular pseudohole.

Methods: The vitreoretinal tomography of idiopathic macular holes and macular pseudoholes was observed with optical coherence tomography (OCT).

Results: In stage 1 and 2, foveolar intraretinal splitting was evident. The posterior hyaloid membrane was detected in 7 of 10 eyes with stage 1 and 2 holes. Dome-shaped vitreoretinal separation was seen in 6 of 7 eyes in which the posterior hyaloid membranes were detected. A complete posterior vitreous detachment was seen around a stage 3 hole. In the macular pseudohole with preretinal membrane, there was anterior and central displacement of the inner retina in the perifoveal region, resulting in a U-shaped deformation of the macular lesion. In contrast, the structure of the central fovea was virtually intact.

Conclusions: On the basis of the OCT findings, the intraretinal splitting and the cyst formation are important features in the development of a macular hole. The dome-shaped vitreoretinal separation in the early stages of macular holes suggests that the posterior hyaloid membrane may not be taut but slack, and would not cause a tractional force continuously even in early-stage macular holes.