Idiopathic full-thickness macular holes and the vitreomacular interface: a high-resolution spectral-domain optical coherence tomography study

Am J Ophthalmol. 2012 Nov;154(5):881-892.e2. doi: 10.1016/j.ajo.2012.05.024. Epub 2012 Sep 5.


Purpose: To analyze the vitreomacular interface in idiopathic full-thickness macular holes (MHs) using spectral-domain optical coherence tomography.

Design: Prospective cross-sectional case series.

Methods: Ninety-one eyes of 86 consecutive patients with a MH were examined by spectral-domain optical coherence tomography. The vitreomacular interface was assessed and the presence or absence of an operculum was analyzed.

Results: Fifty-two eyes had a stage 2 MH, 12 eyes a stage 3 MH, and 27 eyes a stage 4 MH. No posterior hyaloid membrane was detected in any eyes with a stage 4 MH. In 35 (54.7%) of the 64 eyes with an MH without a complete posterior vitreous detachment (PVD), we saw a perifoveal PVD with vitreofoveal adhesion and partial dehiscence of the raised inner retina with an outer retinal separation in the MHs. In 24 (37.5%) of the 64 eyes without a complete PVD, an operculum, which is a hyperreflective structure of the foveal retina, was in front of the MH. The posterior hyaloid membrane was separated completely but adhered to the optic disc. In 2 (3.1%) of the 64 eyes without a complete PVD, the posterior hyaloid membrane was separated from the macula without an operculum. In 3 (4.7%) of the 64 eyes without a complete PVD, vitreofoveal adhesion on both edges of the hole was connected to the taut posterior hyaloid membrane without an operculum.

Conclusions: The vitreomacular interface had 4 configurations in MHs without a complete PVD. Approximately 55% of cases with an open roof in the eyes without a complete PVD may be at risk for progression to operculum formation (loss of retinal tissue).

MeSH terms

  • Aged
  • Aged, 80 and over
  • Basement Membrane / pathology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Retina / pathology*
  • Retinal Perforations / diagnosis*
  • Tissue Adhesions
  • Tomography, Optical Coherence*
  • Visual Acuity / physiology
  • Vitreous Body / pathology*
  • Vitreous Detachment / diagnosis