MACULAR HOLE

A macular hole is a full-thickness defect of retinal tissue involving tile anatomic fovea ea, thereby affecting central visual acuity. Macul ar holes halt been associated with myriad ocular conditions and origin ally were described in the setting of trauma. The pathogenesis of idio pathic, age-related macular holes remains unclear despite a litany of theories. Recently, Gass has described an updated biomicroscopic class ification of macular holes and postulated that tangential vitreous tra ction mau play a role. Cellular components surrounding the rim of macu lar holes may also contribute tangential traction forces and elevate t he rim. Pseudomacular holes may be mistaken for macular hole lesions, despite careful clinical examination. Careful biomicroscopic examinati on with a contact lens and use of the Watzke and laser aiming beam tes ts help to ensure accurate diagnosis. Newer imaging technology, such a s optical coherence tomography, helps distinguish true macular holes f rom pseudoholes and may provide additional insight into the pathogenes is of this condition. Surgical management with or without pharmacosurg ical adjuncts carl improve vision in select cases. The most common sur gical complication is progressive lens opacification in phakic patient s. (C) 1998 by Elsevier Science Inc. All rights reserved.).