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What is a macular hole?
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原發性黃斑部裂孔(Macular Hole) 視網膜和黃斑部的功能是什麼? 眼睛的構造就像一部照相機； 視網膜. (類似相機裡的底片)在眼睛後方佈滿了很多的神經細胞的敏感組織，用來接受訊息。 視網膜最中心 黃斑部. (是感光細胞密度最高的區域)掌控了最中心視力； ①構造很袖珍：整個大小直徑約為0.55cm但是它所掌控的視力範圍，卻是眼前20度約為15吋電腦螢幕4/5的大小。 ②視覺最傳神：面積約佔視網膜的5%，但是其影像訊息傳達卻佔用腦部視覺中樞神經細胞一半左右,讓我們能夠更清晰地看到形狀和顏色。 所以大腦意識上想要看哪裡就是由黃斑部來負責。 玻璃體. 是眼球內體積最大的組織,主要由膠原蛋白纖維跟水組成，位於眼球水晶體跟視網膜之間。
- Pathophysiology
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Different findings can be observed depending the stage of the MH. Residual cortical vitreous, retinal glial, and retinal pigment epithelial cells are often found on the retinal surface. They are thought to cause tangential traction on the fovea. Cystoid edema in the outer plexiform and inner nuclear layers and thinning of the photoreceptor layer ca...
It has been hypothesized that MHs are caused by tangential traction as well as anterior posterior vitreoretinal traction of the posterior hyaloid on the parafovea. MHs are noted to be a complication of a posterior vitreous detachment (PVD) at its earliest stages.
There are no preventative measures for idiopathic MHs. Pars plana vitrectomy has not been clearly demonstrated to be effective in preventing MH formation. Careful examination of the fellow eye is also recommended given that MHs are bilateral in up to 30% of patients.[2] Special attention should be paid to the vitreoretinal interface, involutional m...
This is a clinical diagnosis based on history and clinical exam, including slit lamp and dilated fundus examination. In some cases, optical coherence tomography (OCT) is useful in the diagnosis and management of this condition. It is important to distinguish between a full-thickness macular hole versus a lamellar hole (irregular foveal contour with...
Patients with MHs typically present over the age of 60 and females are more frequently affected. Idiopathic MH occur with an estimated incidence of 8.69 eyes per 100,000 population per year in one study[1]. A careful history should be obtained to investigate for any of the risk factors mentioned above.
Metamorphopsia (distortion of the central vision), central visual loss, or central scotoma can be reported.
More recently, the The International Vitreomacular Traction Study (IVTS) Group also formed a classification scheme of vitreomacular traction and macular holes based on OCT findings[5]:
Other features to note on exam include yellow deposits at the base of the hole, retinal pigment epithelial changes at the base of the hole, and epiretinal membrane adjacent to hole.
The clinical stage and duration of the MH is the most important issue in the management of this entity.
In general, most Stage 1 MH can be followed conservatively given approximately 50% chance of spontaneous closure[6]. However, if the patient has symptomatic VMT or even a full-thickness macular hole with associated VMT, some may consider one of the following treatment options: Regardless of which treatment is pursued, the patient should be followed...
The follow up is similar for most eyes following pars plana vitrectomy surgery. It is important that patients understand the importance of postoperative positioning. While the duration of positioning has been debated, most vitreoretinal surgeons advise positioning to improve the rate of hole closure. Visual acuity improvement does not occur immedia...
The complications are similar to all eyes undergoing pars plana vitrectomy. In particular, these patients are at a higher risk for retinal tear and detachment. The vitreous is the most adherent to the optic nerve, macula, and vitreous base. Patients with macular holes may inherently have an abnormal vitreoretinal interface, and thus, during certain...
The visual outcomes following pars plana vitrectomy are very favorable. In general, better the preoperative visual acuity results in better postoperative visual acuity. However, eyes with worse preoperative visual acuity often experience the greatest absolute postoperative improvement. A small number of macular holes can recur after a successful cl...
2023年4月12日 · A macular hole is an actual hole or a full-thickness disorder in the macula of your eye, the central part of your retina. The retina is the part of your eye that contains nerve cells that react to light and allow us to see. A macular hole generally happens in just one eye, although it can happen in both eyes.
而黃斑部裂孔(Macular hole)，是指黃斑部區域的視網膜發生破洞的現象，大多在中央小窩的位置，因此影響視力甚鉅。 最常見的原因是自發性的，其他危險因子包括：玻璃體牽引、視網膜上增生膜、高度近視、挫傷、眼球內發炎、糖尿病等。
2023年12月11日 · Macular hole is when a circular opening forms in your macula. As the hole forms, things in your central vision will look blurry, wavy or distorted. As the hole grows, a dark or blind spot appears in your central vision. A macular hole does not affect your peripheral (side) vision. What Causes a Macular Hole?
Macular holes (MH) result in central vision loss, metamorphopsia, and a central scotoma. Idiopathic macular holes (IMHs) ac count for 83% of cases; they are found more commonly in females and are associated with increased age.
2023年11月15日 · A macular hole is a rare eye condition that can blur the central vision you use to do everyday tasks like driving or reading. The macula is a small area in the center of the retina (the light-sensitive layer of tissue in the back of the eye). Macular holes happen when an opening forms in the macula — usually after being stretched or pulled.
