Pathogenesis of idiopathic macular hole based on optical coherence tomograph

Abstract

Objective To discuss the pathogenesis of idiopathic macular hole (IMH) based on the characteristics of optical coherence tomography (OCT) images.Method The OCT images of IMH in 39 cases (43 eyes) were collected and were divided into different stages according to the standard of Gass.The image of 17 eyes showed atage 2 -4 IMH.They had been performed vitrectomy combined with inner limiting membrane peeling surgery.Results In 5 eyes of stage 1 IMH,traction from posterior vitreous detachment (PVD) at fovea was observed in 4 eyes (80％).In 13 eyes of stage 2 IMH,traction from PVD at fovea was observed in 12 eyes (76.9％).In stage 3 -4 IMH,vitreous have separated from fovea.In which epimacular mebrane was found in 11/16 eyes (68.7％) of stage 3 IMH,and 7/9 eyes (77.8％) of stage 4 IMH.In stage 2 - 4 IMH,cystic lesion had been found at the edge of the hole in each image,curling up like “fish mouth”.But all the cystic lesion and “fish mouth” sign were disappeared after vitrectomy combined with inner limiting membrane peeling.Conclusion In stage 1 of IMH,the main pathogenesis is the fore-and-back traction of PVD at fovea; In stage 3 - 4 IMH,the main pathogenesis is the centrifugal tension from joint action of inner limiting membrance and epimacular membranes.The above two kinds of mechanism are co-existed for the development of the hole in stage 2 IMH. Key words: Macular hole, idiopathic ; Pathogenesis