Full-thickness Hole Research Articles

Delayed Spontaneous Closure of a Full Thickness Myopic Macular Hole with Good Visual Recovery

Purpose: To present the longitudinal progression of a myopic macular hole with eventual closure and excellent visual recovery over a decade after initial full-thickness hole formation. Methods: The patient was monitored using time-domain and spectral-domain optical coherence tomography images over 16 years. Results: A 68-year-old man with high myopia was referred for surgical evaluation of a full-thickness macular hole and retinal detachment of his left eye, which were repaired. At initial presentation, the fellow eye demonstrated a lamellar hole, which eventually also progressed to become a full-thickness macular hole. The patient subsequently declined surgery and was observed semiannually over the course of 16 years. At 10 years following initial injury, the full-thickness macular hole closed spontaneously. The visual recovery was excellent with an acuity of 20/25. Conclusion: Although surgical intervention remains the mainstay of treatment for macular holes, patients who are not surgical candidates may still have good visual and anatomic outcomes even long after initial hole formation. Lamellar hole epiretinal proliferation material is frequently seen in myopic full-thickness macular holes and may be associated with eventual delayed hole closure due to their slow progression.

Intravitreal clindamycin-induced macular infarct in a case of ocular toxoplasmosis

Intravitreal clindamycin is one the modalities in managing ocular toxoplasmosis. Here we report clindamycin-induced macular infarct followed by full thickness macular hole with epiretinal membrane and macular atrophy. A 54-year-old male diagnosed with ocular toxoplasmosis in the right eye was treated with intravitreal injection of clindamycin and dexamethasone. Patient developed macular infarction with epiretinal membrane (ERM) and full thickness hole, with corresponding decrease in visual acuity and was managed with vitrectomy. Clindamycin injection has potential to cause retinal complications, and hence, one needs to be extremely cautious while preparing the proper concentration of clindamycin as it requires appropriate dilution.

Management of Laparochisis with Atresia in Underdevelopment Country: Fousseyni Daou Hospital in Kayes (Mali): About a Case

Gastrochisis is a herniation of the abdominal viscera through a full-thickness hole in the abdominal wall, usually located to the right of the umbilical cord insertion. It is estimated at 1/4000 to 1/10000 births, but there are significant geographical variations, with a high mortality rate in developing countries [1, 3, 4]. We report a case operated on at the Fousseyni Daou hospital in Kayes in 2019. This female child was born at home in septic conditions and was referred to us for care. The aim of this study was to determine the difficulties related to the management of laparochisis, especially with atresia, but also to describe the therapeutic and evolutionary aspects.

Müller cells and astrocytes in tractional macular disorders.

Tractional deformations of the fovea mainly arise from an anomalous posterior vitreous detachment and contraction of epiretinal membranes, and also occur in eyes with cystoid macular edema or high myopia. Traction to the fovea may cause partial- and full-thickness macular defects. Partial-thickness defects are foveal pseudocysts, macular pseudoholes, and tractional, degenerative, and outer lamellar holes. The morphology of the foveal defects can be partly explained by the shape of Müller cells and the location of tissue layer interfaces of low mechanical stability. Because Müller cells and astrocytes provide the structural scaffold of the fovea, they are active players in mediating tractional alterations of the fovea, in protecting the fovea from such alterations, and in the regeneration of the foveal structure. Tractional and degenerative lamellar holes are characterized by a disruption of the Müller cell cone in the foveola. After detachment or disruption of the cone, Müller cells of the foveal walls support the structural stability of the foveal center. After tractional elevation of the inner layers of the foveal walls, possibly resulting in foveoschisis, Müller cells transmit tractional forces from the inner to the outer retina leading to central photoreceptor layer defects and a detachment of the neuroretina from the retinal pigment epithelium. This mechanism plays a role in the widening of outer lameller and full-thickness macular holes, and contributes to visual impairment in eyes with macular disorders caused by conractile epiretinal membranes. Müller cells of the foveal walls may seal holes in the outer fovea and mediate the regeneration of the fovea after closure of full-thickness holes. The latter is mediated by the formation of temporary glial scars whereas persistent glial scars impede regular foveal regeneration. Further research is required to improve our understanding of the roles of glial cells in the pathogenesis and healing of tractional macular disorders.

Navigated single-capture 3D and cross-sectional wide-field OCT of the mid and peripheral retina and vitreoretinal interface.

Assess the mid and peripheral neuroretina and vitreoretinal interface using a novel Navigated Single-Capture 3D and Cross-Sectional Wide-Field Swept-Source Optical Coherence Tomography (WF SS-OCT) technology with correlation to Multi-Wavelength Ultra-Widefield Imaging (MW UWFI) and Histopathology reference. Retrospective observational study. A total of 74 patients (148 eyes) were imaged using WF SS-OCT and Navigated Single-Capture twelve 23 mm cross-sectional radial scan pattern at 15° intervals. Image diagnosis included: congenital hypertrophy of the retinal pigment epithelium, choroidal nevus, ora serrata pearls, retinal tuft, lattice, snail track, cobblestone degeneration, retinal hole, retinal tear, degenerative retinoschisis, peripheral laser retinopexy, white without pressure, vitreous floaters, subclinical peripheral rhegmatogenous retinal detachment (RD), and tractional RD in proliferative diabetic retinopathy. WF SS-OCT images were correlated with MW UWFI and histopathological references where available. WF SS-OCT successfully imaged structural features in all diagnoses with significant improvement in diagnostic capability and increased the diagnosis of specific features such as vitreoretinal attachment, full thickness hole or tear and subretinal fluid. Histopathological correlation was available for five (5) different peripheral retinal pathologies imaged by both WF SS-OCT and MW UWFI and good anatomical correlation was observed in all diagnosis. Navigated Single-Capture 3D and Cross-Sectional WF SS-OCT provides detailed anatomic information of the mid and peripheral neuroretina and vitreoretinal interface, allowing early recognition of vision-threatening features that may influence clinical management, particularly in an era of telemedicine or when there is limited or no access to Indirect Ophthalmoscopy with 360° Scleral Indentation.

Full-thickness retinal hole after nd:yag laser hyaloidotomy treatment of subhyaloid hemorrhage secondary to valsalva maneuver

Full-thickness retinal hole after nd:yag laser hyaloidotomy treatment of subhyaloid hemorrhage secondary to valsalva maneuver

Idiopathic Macular Hole Preferred Practice Pattern®

Idiopathic Macular Hole Preferred Practice Pattern®

Paravascular abnormalities in eyes with idiopathic epiretinal membrane.

The purpose was to investigate the paravascular abnormalities (PVA) around the retinal vascular arcades and their post-operative evolution in eyes with epiretinal membranes (ERM). This is an observational case series. Fifty-seven eyes of 55 patients with concurrent PVA and ERM were studied (study group). Forty-one eyes in 41 patients with ERM but no PVA served as controls. Multiple optical coherence tomography (OCT) scans were made along the upper and lower arcades and across the fovea in each patient. Serial fundus photography and OCT scans were performed in eyes receiving an operation. All surgeries were performed by one surgeon. The incidence and location of paravascular retinal cysts, deep cystic spaces underneath the vessels, and paravascular retinal defects, as well as vitreoretinal interface changes, were determined and correlated with macular thickness. In the study group, paravascular retinal cysts were detected in 57 eyes (100%), deep cystic spaces in nine eyes (15.8%), and paravascular lamellar holes in 31 eyes (54.4%). No case had a full-thickness hole. ERM adhesion to the PVA was noted in 16 eyes (28.1%) and internal limiting membrane (ILM) changes over the PVA in 22 eyes (38.6%). Compared with the control, the study group had significantly increased macular thickness. PVA, except lamellar holes, disappeared or decrease in severity after ERM and ILM removal surgery. Different types of PVA are relatively common in eyes with ERM. Our findings suggest that PVA may develop secondary to ERM-induced macular thickening. Except for lamellar holes, most lesions decrease following an operation.

Managing Macular Holes in a Developing Economy

Background: Macular holes are the common cause of visual impairment especially in the elderly and have a variety of etiological factors. The advances in the management of macular holes are encouraging and are now available in developing countries although scarce, where hitherto; patients seek attention outside their country. The need to understand this disease has therefore become pertinent in all retina clinics. Objective: To evaluate the pattern of presentation of macular holes and its management in a retina clinic in South South Nigeria. Methods: A 5 year retrospective, non comparative review of 24 consecutive cases presenting to a retinal clinic was carried out. Relevant information was extracted from the medical records and analyzed. Results: Three hundred and sixty four cases were seen between January 2009 and December 2013. Twenty four cases had macular holes and ten (41.7%) had bilateral presentation with a total of 34 eyes. The incidence of macular holes was 6.6%. The mean age was 46 years (SD ± 13.42) with a female preponderance, 5:1. Idiopathic holes formed the bulk of the cases 14(58.3%); others were trauma 4(16.7%), posterior uveitis 2, (8.3%), chemotherapy 2 (8.3%), Solar retinopathy and retinitis pigmentosa 1 (4.2%). Nineteen (55.9%) of the 34 eyes were visually impaired (BCVA <6/18). Nineteen eyes had full thickness holes (55.9%) requiring surgery, however only 3(12.5%) of these could afford to have surgery with one reoperation. Four patients (16.7%) had complications in form of retinal detachments at presentation. Conclusion: This study has shown that the incidence of macular holes in the developing world is significant and resources to manage these cases are grossly lacking. Specialist training, with government subsidizing costs will alleviate these difficulties and reduce visual loss from macular holes.

Paracentral retinal holes occurring after macular surgery: incidence, clinical features, and evolution

To describe the incidence, clinical features, and evolution of paracentral retinal holes occurring after macular surgery. A retrospective non-randomized study of 909 patients operated on for either a macular hole (MH, n = 400 patients) or an epiretinal membrane (ERM, n = 509 patients) between 2004 and 2009. Six patients (0.6%) developed a paracentral macular hole after surgery. Their clinical, auto-fluorescence, and optical coherence tomography (OCT) characteristics as well as their visual outcomes were studied. The mean age of patients was 70years. Paracentral holes occurred approximately 5weeks after surgery (with a range of 2-12weeks). All patients were asymptomatic. Five patients underwent ILM peeling during initial surgery. Paracentral retinal holes were located superiorly to the fovea in three cases and temporally in the other three cases. Mean pre-operative BCVA was 20/200 and mean post-operative BCVA was 20/40. The eye where the eccentric MHs were closest to the fovea (inferior to 1 optic disc area) had the poorest final visual acuity. Autofluorescence imaging showed a bright fluorescence in paramacular holes. On OCT images, they were shown to be flat full-thickness holes. No treatment was attempted. No rhegmatogenous complications or choroidal neovascularization occurred in any of the patients. Mean follow-up was 2years. In summary, paracentral MHs are uncommon complications which can occur at the site where ILM peeling has been initiated or completed. Except for the closest holes to fovea, they have good visual prognosis and do not require any treatment underlining the importance of initiating the ILM peeling as far as possible from the fovea.

Automated macular pathology diagnosis in retinal OCT images using multi-scale spatial pyramid and local binary patterns in texture and shape encoding

We address a novel problem domain in the analysis of optical coherence tomography (OCT) images: the diagnosis of multiple macular pathologies in retinal OCT images. The goal is to identify the presence of normal macula and each of three types of macular pathologies, namely, macular edema, macular hole, and age-related macular degeneration, in the OCT slice centered at the fovea. We use a machine learning approach based on global image descriptors formed from a multi-scale spatial pyramid. Our local features are dimension-reduced local binary pattern histograms, which are capable of encoding texture and shape information in retinal OCT images and their edge maps, respectively. Our representation operates at multiple spatial scales and granularities, leading to robust performance. We use 2-class support vector machine classifiers to identify the presence of normal macula and each of the three pathologies. To further discriminate sub-types within a pathology, we also build a classifier to differentiate full-thickness holes from pseudo-holes within the macular hole category. We conduct extensive experiments on a large dataset of 326 OCT scans from 136 subjects. The results show that the proposed method is very effective (all AUC>0.93).

Laser assisted zona hatching: What is the evidence to justify its use?

1. IntroductionHatching of the human embryo is necessary for endometrialimplantation. Therefore, this step necessarily has to occur inall successful pregnancies (1). Problems with the hatching pro-cess are thought to be a core reason for pregnancy failure inassisted reproductive technologies (ART) cycles (2). ART, par-ticularly in vitro fertilization (IVF), has been thought to beassociated with a thickened or dense zona that decreases thelikelihood of embryo hatching (3). Specifically, advancedmaternal age, repeated implantation failure, poor embryoquality, IVF culture environment, and cryopreservation haveall been cited as factors that may be associated with a de-creased rate of unassisted hatching (3,4).Assisted hatching (AH) was devised in an attempt to artifi-cially thin the zona pellucida (ZP) of cleavage embryos or blas-tocysts before embryo transfer, thus aiding the hatchingprocess (1,3). In 1990, Cohen and colleagues described theuse of micromanipulation to promote hatching followingIVF by introducing an artificial incision in the ZP of embryosjust prior to replacement in the uterus (5). This process wasnamed ‘assisted hatching’ (5). This 1990 report was the firstto show that AH confers a favorable impact on pregnancy(5). Since that time, multiple methods for AH have been ex-plored. Protocols have been described that create a full thick-ness hole through the entire zona, accomplished by mechanicalmanipulation (often with either a glass microneedle or piezo-micromanipulator), chemical application (often with acidifiedTyrode’s solution), or laser (1,2). Other methods describe thin-ning the zona, accomplished through proteolytic enzymes,acidified Tyrode’s solution, or laser (2,4).2. ControversiesThe role of AH has been the source of much debate. Irrespec-tive of the technical approach, AH remains a procedure of lar-gely unproven worth, regardless of how theoretically appealingit might seem to apply to poorer prognosis IVF cases (6).While some centers have adopted the practice of routinely per-forming assisted hatching, others do not believe that this tech-nology confers a significant clinical benefit (7). Two meta-analyses of studies evaluating potential benefits of AH re-ported significant heterogeneity among study results, suggest-ing that effects of AH may differ depending on patientcharacteristics (8). Both concluded that there is strong evidencethat AH increases pregnancy rates among patients with a his-tory of previous IVF failures (8). An in vitro observation ofover 300 research embryos left in culture till day-9 of develop-ment showed a distinct reduction in both blastocyst formationand hatching relative to increased age of the patients (6). Thisobservation suggested that a compromised ZP may play a rolein restricting blastocyst hatching both in older women and incouples whose embryos develop more slowly (6). However, itremains uncertain whether AH is beneficial to other patientpopulations. The belief by many that AH has a role to playin improving pregnancy rates in certain patient populationshas led to a number of trials evaluating the efficacy of AH ina variety of different clinical situations (2).A recent Cochrane review evaluated 28 AH trials encom-passing 1229 clinical pregnancies and 3646 women (2). The re-sults from this review concluded that assisted hatching maynot only improve clinical pregnancy rates but may also carrya risk of an increased incidence of multiple pregnancies. Thisreview did not find a statistical advantage to one method ofAH versus another. There are numerous recent studies thatdo indicate an advantage to assisted hatching in the properlyselected clinical indications, such as patients whose embryoshave a thickened zona, patients with elevated FSH, older pa-tients, and patients using cryopreserved embryos (6,8). Onthe other hand, the benefit of AH in good prognosis patientsis less clear (4,8). Furthermore, one could argue that the evi-dence used to justify the application of AH to poorer qualityembryos appears circumstantial (6).

Macular holes and central retinal detachment

Dear Editor, A macular hole is a retinal disease primarily affecting elderly patients with an overall prevalence of approximately 0.1%–0.2% (la Cour & Friis 2002; Wang et al. 2006). The pathogenesis of macular holes has been elucidated in recent studies employing optical coherence tomography and ultrasound. These studies have made it apparent that most patients with impending macular holes have a perifoveal vitreous detachment with focal attachment of the vitreous to the foveal umbo as well as a cystoid cleavage in the inner part of the umbo (Gaudric et al. 1999). Transition from an impending hole to a stage 2 full thickness hole starts with a dehiscence in the roof of the cystoid lesion. Centrifugal traction, the cause of which remains elusive, causes the dehiscence to spread outwards into the photoreceptor layer, causing a full thickness defect (Gass 1999; Gaudric et al. 1999). As a macular hole can be associated with a central retinal detachment, we performed the present study to assess the prevalence rate of a central retinal detachment in a group of subjects with macular holes and the association of a collateral retinal detachment with refractive error. The retrospective, interventional case series study included all patients with a macular hole, who were consecutively referred and treated by a primary pars plana vitrectomy in the same surgical unit. Patients with an ocular contusion or other ocular trauma as potential cause for the macular hole were excluded. In a retrospective chart research, we obtained preoperative data on best-corrected visual acuity, intraocular pressure, refractive error, lens status, and previous ocular surgeries. The statistical analysis was performed using a commercially available statistical analysis programme (SPSS, version 17.0; Chicago, IL, USA). The inclusion criteria were met by 171 eyes (167 patients; 108 women). The mean age was 69.5 ± 10.7 years (mean ± standard deviation) (median: 71.1 years; range: 49.5–86.0 years), the mean refractive error was −0.62 ± 4.11 dioptres (median: 0 dioptres; range: −22.4 to +7.0 dioptres), and the mean intraocular pressure measured 15.0 ± 3.2 mm Hg. A central retinal detachment defined as a detached macular area with a diameter of at least 2 disc diameters was present in 5 (2.9%) eyes. The refractive error was significantly (p <0.001) more myopic in the subgroup with a central retinal detachment (−15.7 ± 6.0 dioptres; range: −22.4 dioptres to −6.75 dioptres) than in the subgroup with the central retina attached (−0.10 ± 2.85 dioptres; range: −17.9 to +7.0 dioptres) (Fig. 1). Out of the 171 eyes, 38 (22%) eyes were pseudophakic. Boxplots showing the distribution of refractive error in eyes with macular holes without central retinal detachment and eyes with a central retinal detachment. The results confirm a recent investigation by Akiba et al. (1999) in which a retinal detachment was associated with a macular hole in severely myopic eyes. According to the study by Akiba et al., only highly myopic eyes with a posterior staphyloma appeared to be at risk for the development of a macular detachment around a macular hole. In our study, the cut-off point between the eyes with a central retinal detachment and those eyes with the central retina attached was at −7 dioptres to −8 dioptres (Fig. 1). Similar results were obtained in other studies in which −6 dioptres to −8 dioptres was the cut-off point between moderate myopia and high myopia with respect to the development of a secondary macrodisc, the presence of myopic retinopathy, and the development of a highly myopic type of normal-pressure glaucoma. The age-related low prevalence of 22% of pseudophakia in the eyes with a macular hole in our study may suggest that cataract surgery relatively often leading to a postoperative vitreous detachment may potentially prevent the development of a full macular hole. Correspondingly, the importance of the vitreous in the pathogenesis of macular holes has been emphasized in previous studies by a low frequency of macular holes in eyes with complete posterior vitreous detachment (Hikichi et al. 1993). Also, macular holes have been shown to be less prone to enlargement, with consequent better preservation of vision, if a posterior vitreous detachment was apparent at the time of diagnosis (Hikichi et al. 1993). In conclusion, a central retinal detachment was found in about 3% of eyes with a macular hole. A central retinal detachment was present only in highly myopic eyes beyond a myopic refractive error of approximately −7 dioptres. It agrees with other studies on a similar cut-off between medium myopia and high myopia. Future studies may address whether cataract surgery is associated with a reduced rate of development of macular holes.

Regeneration of Skull Bones in Adult Rabbits after Implantation of Commercial Osteoinductive Materials and Transplantation of a Tissue-Engineering Construct

We performed a comparative study of reparative osteogenesis in rabbits with experimental critical defects of the parietal bones after implantation of commercial osteoinductive materials "Biomatrix", "Osteomatrix", "BioOss" in combination with platelet-rich plasma and transplantation of a tissue-engineering construct on the basis of autogenic multipotent stromal cells from the adipose tissue predifferentiated in osteogenic direction. It was found that experimental reparative osteogenesis is insufficiently stimulated by implantation materials and full-thickness trepanation holes were not completely closed. After transplantation of the studied tissue-engineering construct, the defect was filled with full-length bone regenerate (in the center of the regenerate and from the maternal bone) in contrast to control and reference groups, where the bone tissue was formed only on the side of the maternal bone. On day 120 after transplantation of the tissue-engineering construct, the percent of newly-formed bone tissue in the regenerate was 24% (the total percent of bone tissue in the regenerate was 39%), which attested to active incomplete regenerative process in contrast to control and reference groups. Thus, the study demonstrated effective regeneration of the critical defects of the parietal bones in rabbits 120 days after transplantation of the tissue-engineering construct in contrast to commercial osteoplastic materials for directed bone regeneration.

Occult Perforating Corneal Injury from Mechanical Pencil Graphite.

An 11-year-old boy was struck in the left eye with a mechanical pencil in a projectile manner. Initial examination under the operating microscope revealed a presumed partial-thickness corneal injury with a retained 8-mm long segment of graphite lead. After removal of the graphite segment, a full-thickness hole in the cornea was revealed under the lead shaft. The proposed mechanism of injury and unique presentation was initial full-thickness penetration followed by lead shaft retraction (likely due to eye rubbing) and then corneal stromal reentry with stromal lamellar dissection and fixation. Prompt removal of the foreign body, corneal laceration repair, and early cataract extraction resulted in postoperative 20/40 uncorrected visual acuity. Mechanical lead pencil injuries represent a unique mechanism of penetrating trauma.

Paracentral retinal defects after vitrectomy for macular hole and their evolution over time.

The aim of this article is to present paracentral defects after macular hole surgery with spectral optical coherence tomography and to discuss its influence on functional outcome. The authors report a spectral optical coherence tomography documented case of paracentral retinal defects in a patient after macular hole surgery. A spectral optical coherence tomography device with an axial resolution of 3 μm was used. The 3-dimensional examination scanned an area of 7 × 7 mm around the macula. Additionally HRT2, macular module scans were performed. A 70-year-old man underwent surgery for macular hole. Best-corrected visual acuity was 0.2 for 2 years after surgery. Paracentral retinal defects, first observed 1 week after surgery, tended to decrease in size. Full-thickness paracentral retinal holes are a rare vitrectomy complication. In this study, we suggest that the cause of those defects can be internal limiting membrane peeling itself, with no component of direct mechanical trauma.

Macular full-thickness and lamellar holes in association with type 2 idiopathic macular telangiectasia

Macular full-thickness and lamellar holes in association with type 2 idiopathic macular telangiectasia

Macular holes: vitreoretinal relationships and surgical approaches

Idiopathic full-thickness macular holes develop as a result of anteroposterior and tangential traction exerted by the posterior vitreous cortex at the fovea. Vitreoretinal relationships during the development of macular holes can be demonstrated in detail by ocular coherence tomography, facilitating an improved understanding of their pathogenesis and guiding clinical management. Surgical strategies for the repair of macular holes are designed to relieve vitreofoveal traction and to promote flattening and reapposition of the macular hole edges by intraocular gas tamponade. A period of face-down positioning postoperatively is conventionally advised. However, the evidence to support this recommendation is weak and practice varies considerably. Surgical removal of the inner limiting membrane (ILM) is advocated to ensure thorough removal of any tangential tractional components including any residual cortical vitreous. Current evidence suggests that ILM peeling can improve anatomical outcomes but the effect on visual function is less predictable; unsuccessful attempts to peel the ILM can be associated with poor visual outcome. The use of vital dyes can facilitate visualisation of the ILM and help achieve complete, atraumatic peeling. Indocyanine green dye can enable high rates of macular hole closure but has been associated with poorer visual outcomes suggesting a dose-dependent toxicity. Trypan blue dye offers an alternative that may have a more favourable risk profile. An improved understanding of vitreoretinal relationships may facilitate a tailored approach to surgery in individuals with macular holes. Vitrectomy to relieve anteroposterior traction is central in the management of all full-thickness holes. The use of long-acting gases, prolonged face-down positioning, and ILM peeling may be more valuable for larger holes, longstanding holes, and those that have failed to close following conventional surgery.

Detection of Paravascular Lamellar Holes and Other Paravascular Abnormalities by Optical Coherence Tomography in Eyes with High Myopia

To investigate the morphologic alterations at or around the blood vessels of the retinal vascular arcade by optical coherence tomography (OCT) in highly myopic eyes. Observational case series. Two hundred eighty-seven eyes of 149 patients with high myopia (refractive error >/=-8.00 diopters [D] or axial length >26.5 mm) were studied. Fifty-six emmetropic (+1.00 to -1.00 D) eyes and 44 eyes with low (<-6.00 D) myopia were examined as controls. The participants had a complete ophthalmologic examination, including stereoscopic fundus observations and OCT examinations. Multiple OCT scans were made along the entire extent of the posterior vascular arcade and across the fovea in each patient. The incidence of paravascular retinal cysts, vascular microfolds, and paravascular retinal holes was determined. Retinoschisis at the retinal vessels and a macular retinoschisis were also evaluated. In 287 eyes with high myopia, paravascular retinal cysts were detected in 142 eyes (49.5%), vascular microfolds in 128 eyes (44.6%), and paravascular retinal holes in 77 eyes (26.8%) by OCT. The paravascular retinal holes were partial-thickness lamellar holes in all of the patients; full-thickness holes were never detected. Vascular microfolds and paravascular lamellar holes were always accompanied by paravascular retinal cysts. Optical coherence tomography examinations revealed the presence of vitreoretinal traction on the inner walls of retinal cysts in sections adjacent to the retinal holes. In the 77 eyes with paravascular lamellar holes, 34 eyes (44.2%) were associated with internal limiting membrane (ILM) detachments and 15 eyes (19.5%) were associated with a macular retinoschisis. In fact, 15 of 18 eyes (83.3%) with a macular retinoschisis had paravascular lamellar holes. None of the 100 control eyes had these paravascular abnormalities. These findings indicate that different types of paravascular abnormalities are relatively common in highly myopic eyes. Our findings suggest that paravascular lamellar holes form when the inner wall of paravascular retinal cysts is avulsed by vitreous traction. The presence of paravascular lamellar holes might enhance the proliferative response of the ILM, and this might be an important causative factor for the development of a macular retinoschisis in highly myopic eyes.

FULL-THICKNESS MACULAR HOLE FORMATION IN IDIOPATHIC PARAFOVEAL TELANGIECTASIS

To describe the macular holes in patients with idiopathic parafoveal telangiectasis (IPT) and to propose a pathophysiologic explanation for their formation. Four eyes of two patients with IPT were evaluated with biomicroscopy and optical coherence tomography (OCT). One patient had a nearly full-thickness hole with preservation of only the internal limiting membrane (ILM), but had a 20/60 visual acuity. The other patient had a large full-thickness macular hole, but retained 20/40 visual acuity. Each patient had a fellow eye showing prominent central inner foveal cavitation under a very thin ILM, which was devoid of associated tissue. This report describes the findings of two patients with IPT who developed pronounced central foveal structural abnormalities. The induced anatomic changes noted in our patients suggest that there is a loss of the structural aspects afforded by Muller cells, particularly the Muller cell cone, in the central macula in patients with IPT. The preservation of good visual acuity in our patients implies that the holes were the result of lateral separation of the photoreceptors within the fovea and that there could not have been profound atrophy of the photoreceptors.