Pathogenei of macular hole and therapeutic implication

Purpoe To review the literature and identify conitencie and inconitencie in exiting theorie of pathogenei and to conider ome of their poible therapeutic implication. Deign Preentation of clinical cae material with a ynthei of idea on macular hole. Method The literature of macular hole urgery i reviewed pertinent to pathogenic theorie. Clinical example of evolving macular hole hown on ocular coherence tomography are preented to illutrate iue. Reult The hitory of pathogenei and macular hole i intereting in that, in many way pathogenic theory ha come full cycle. Initially, anteropoterior traction wa thought to caue direct formation of a macular hole. ubequently, degenerative and then tangential tractional etiologie were propoed. Current imaging tudie have greatly advanced our undertanding of anatomic feature of full-thickne hole and early full-thickne hole condition. Thee are mot conitent with a focal anteropoterior traction mechanim, but ome inconitence in clinical cae ugget a role for degeneration of the inner retinal layer. Concluion Degeneration of the inner retinal layer at the central fovea may predipoe the eye to macular hole formation. What may otherwie be incidental tractional force appear to initiate the hole. Thee tractional element are oriented perpendicularly to the retinal urface, rather than tangentially. Further obervation, epecially with equential obervation from ocular coherence tomography, may yield further inight into the pathogenei of macular hole a well a implication regarding the bet repair technique.