K Mori1, T Abe, S Yoneya. 1. Department of Ophthalmology, Saitama Medical School, Iruma, Japan.
Abstract
PURPOSE: To clarify the role of the posterior vitreous cortex in macular hole development, we evaluated the follow-up findings of clinical observations and optical coherence tomography (OCT) images of macular holes in early stage. METHODS: The vitreoretinal tomography was examined and followed in eyes with stage 1 and 2 macular holes with OCT. RESULTS: The posterior cortical vitreous was identified in 12 of 17 eyes with early-stage macular holes by OCT (71%). In these eyes, the detached posterior vitreous appeared to be merged to the fovea and the disc. The vitreoretinal separations showed typically dome-shaped. A long scan along the papillomacular axis also delineated the posterior vitreous face as dome-shaped perifoveal vitreous detachment with adhesion to the fovea and disc. Repetitive OCT examinations clearly demonstrated the course of development of the macular hole. CONCLUSIONS: The dome-shaped vitreoretinal separation seen with OCT gives rise to an idea that the posterior vitreous cortex may not be taut but slack, and would not cause a continuous tractional force even in early-stage macular holes. This finding brings us an idea that the tangential traction at the fovea may be generated by fluid movements, rather than by contraction of the cortical vitreous.
PURPOSE: To clarify the role of the posterior vitreous cortex in macular hole development, we evaluated the follow-up findings of clinical observations and optical coherence tomography (OCT) images of macular holes in early stage. METHODS: The vitreoretinal tomography was examined and followed in eyes with stage 1 and 2 macular holes with OCT. RESULTS: The posterior cortical vitreous was identified in 12 of 17 eyes with early-stage macular holes by OCT (71%). In these eyes, the detached posterior vitreous appeared to be merged to the fovea and the disc. The vitreoretinal separations showed typically dome-shaped. A long scan along the papillomacular axis also delineated the posterior vitreous face as dome-shaped perifoveal vitreous detachment with adhesion to the fovea and disc. Repetitive OCT examinations clearly demonstrated the course of development of the macular hole. CONCLUSIONS: The dome-shaped vitreoretinal separation seen with OCT gives rise to an idea that the posterior vitreous cortex may not be taut but slack, and would not cause a continuous tractional force even in early-stage macular holes. This finding brings us an idea that the tangential traction at the fovea may be generated by fluid movements, rather than by contraction of the cortical vitreous.