Macular Hole Workup

  • Author: Kean Theng Oh, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Jul 7, 2011
 

Imaging Studies

  • Ocular coherence tomography (OCT) allows high-resolution cross-sectional imaging of the retina. OCT allows the physician to detect the presence of a macular hole as well as changes in the surrounding retina.
    • OCT can distinguish lamellar holes and cystic lesions of the macula from macular holes.
    • Also, the status of the vitreomacular interface can be evaluated. This allows the clinician to evaluate the earliest of the stages of a macular hole as well as evaluate for other vision-limiting conditions associated with macular holes, such as a surrounding cuff of subretinal fluid.
  • Fluorescein angiography (FA) may be a useful test in differentiating macular holes from masquerading lesions, such as CME and choroidal neovascularization (CNV).
    • Full-thickness stage 3 holes typically produce a window defect early in the angiogram and do not expand with time as depicted below. The arteriovenous phase of the angiogram best demonstrates a granular hyperfluorescent window associated with the overlying pigment layer changes. Fluorescein angiogram showing a central window defFluorescein angiogram showing a central window defect.
    • No leakage or accumulation of dye is observed as opposed to other lesions.
    • In CME, a gradual accumulation of dye occurs in the cystoid spaces, eventually demonstrating a petaloid appearance late in the angiogram.
  • B-scan ultrasonography may be helpful in elucidating the relationship of the macula to the vitreous; therefore, it may be helpful in staging the disease but is not sensitive to distinguish a true macular hole from masquerading lesions.
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Other Tests

  • Amsler grid abnormalities, although sensitive for macular lesions, are not specific for macular holes. Plotting of small central scotomas caused by full-thickness macular holes using the Amsler grid is difficult because of the poor fixation in the affected eye. However, bowing of the lines and micropsia frequently are appreciated. This could be attributable to the surrounding area of retinal edema and intraretinal cysts, which could be seen in macular holes as well as other lesions like CNV.
  • Microperimetry and multifocal electroretinography have also been used to evaluate patients with idiopathic macular holes. These studies show loss of retinal function corresponding to the macular hole with subsequent recovery of function following surgical repair of the hole.
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Contributor Information and Disclosures
Author

Kean Theng Oh, MD  Consulting Staff, Associated Retinal Consultants, PC

Kean Theng Oh, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Bradley M Hughes, MD  Assistant Professor, Department of Ophthalmology, Retina and Vitreous Service, University of Arkansas for Medical Sciences

Bradley M Hughes, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Neal H Atebara, MD  Private Practice, Retina Center of Hawaii

Neal H Atebara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, Hawaii Medical Association, and Retina Society

Disclosure: Nothing to disclose.

John H Drouilhet, MD, FACS  Clinical Professor, Department of Surgery, Section of Ophthalmology, University of Hawaii, John A Burns School of Medicine

John H Drouilhet, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Brian A Phillpotts, MD  Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine

Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Sherman O Valero, MD, to the development and writing of this article.

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Full-thickness macular hole showing a surrounding cuff of subretinal fluid.
Full-thickness macular hole with typical yellowish granular deposits on the retinal pigment epithelium.
Fluorescein angiogram showing a central window defect.
Preoperative fundus photograph of a macular hole.
Fundus photograph of the same patient as in the image above at 6 months postoperatively. Note the increased media opacity caused by cataractous changes of the lens.
Fundus photograph of a stage 1a macular hole with characteristic yellow spot at the center of the fovea.
 
 
 
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