Full thickness macular hole formation preceded by lamellar macular defects in the context of complete posterior vitreous detachment

Author: Julian Elias Klaas (Germany)

Co-authors: Julian Elias Klaas, Nathalie Bleidißel, Nikolaus Feucht, Jakob Siedlecki, Siegfried Priglinger, Mathias Maier

Purpose

To describe the morphology of the vitreoretinal interface preceding full thickness macular hole (FTMH) formation in relationship to the posterior vitreous detachment (PVD) status with optical coherence tomography (OCT).

Setting/Venue

Retrospective cohort study

Methods

The clinical and morphological data of 47 consecutive patients with a diagnosis of FTMH were retrospectively screened for fellow eye involvement. OCT images of fellow eyes were reviewed at baseline and all available follow-up exams for: evidence of tractive maculopathy (e.g. epiretinal membrane, vitreomacular traction, FTMH), evidence of lamellar macular defects, irregularities of foveal contour, irregularities of inner and outer retinal layers and the status of vitreopapillary adhesion (VPA).

Results

The mean follow-up time was 26.76 (SD 47.92) months. In 6 of 47 fellow eyes (12.77 %) a FTMH developed over the time range of 6-27 months after the first presentation. In 3 of these cases (50%) the FTMH developed in the presence of an attached posterior vitreous and was preceded by either vitreomacular adhesion or vitreomacular traction. In the other 3 cases (50%) the FTMH developed after complete PVD and was preceded by lamellar macular defects in all cases. Lamellar macular defects in the fellow eye, if present, were in all 3 cases (100%) associated with later FTMH development.

Conlusions

The study of the fellow eye makes it possible to study vitreoretinal pathologies at a point of time, when patients may still be asymptomatic. This retrospectice cohort study describes the pathophysiological role of lamellar macular defects in the formation of full thickness macular holes, especially in the context of complete PVD and prior fellow eye involvement.

Financial Disclosure

J E Klaas has received speaker honoraria for Novartis. No conflicts of interest.

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