Macular Hole: Etiology, Physiopathology, Diagnosis, Differential Diagnosis, and Treatment

Retinal defects evolving whole neural layers in the macular area especially in the fovea are being called macular hole (idiopathic macular hole; IMH). It causes painless central visual loss and deterioration of vision that is called metamorphopsia. Antero-posterior dynamic forces (vitreomacular traction; VMT) caused by tangential tractional vectors of the prefoveal vitreous cortex and progression to full-thickness macular hole due to weakening of the inner retinal layers are attributed for the etiology of macular hole. IMH is seen frequently unilaterally in females and patients > 65 years of age. An approach for IMH treatment, aiming to release the traction and closure of the macular hole by pharmacological vitreolysis is the use of ocriplasmin, which is a plasmin derivative. To release the synechia on the vitreomacular interface and to normalize the abnormalities of the retinal surface are the aims of IMH surgery. Besides, vitreoretinal surgery constitutes suitable conditions for the closure of the hole. Separation and detachment of the posterior hyaloid, core vitrectomy, removal of the peripheral vitreous, and Internal Limiting Membran (ILM) peeling are the standard stages of the classic IMH surgery. Condition of the other eye, presence of Epiretinal Membran (ERM), hole width, patient's age, and quality of life are important factors when evaluating the patients. Ocriplasmin alternative must be kept in mind in holes smaller than 400 μ especially if VMT is existent. IMH is such a pathology that can be treated successfully by vitrectomy and ILM peeling at the present situation.