Morphologic analyi of tage 3 and tage 4 macular hole: Implication for treatment

Purpoe To determine whether the oberved anatomy of macular hole can be explained by a hydrodynamic model in which fluid flow through the hole i balanced by fluid pumping acro the retinal pigment epithelium. We ue thi model to draw concluion about the poible role of vitreomacular traction in determining the anatomy of macular hole and their reolution after vitreou urgery. Deign Cro ectional. Method Retropective tudy in a clinical practice. The tudy included 42 eye of 42 patient with a tage 3 or 4 macular hole (Ga claification). We meaured the radiu of the macular hole and the radiu of the urrounding cuff of ubretinal fluid from color or red-free fundu photograph and determined the relationhip between thee two variable. Reult The mean age of the patient wa 68.0 ± 7 year (range, 51 to 80). Twenty-five patient had tage 3 macular hole and 17 patient had tage 4 macular hole. The neuroenory detachment radiu wa related to the quare of the macular hole radiu for tage 3 and tage 4 hole, with no ignificant difference between the tage 3 and tage 4 linear trend line (P = .999). There wa no correlation between patient age and the area of the macular hole (r = 0.0645) or neuroenory detachment plu hole (r = 0.156) over the range of age in thi tudy. However, the area of the doughnut-haped cuff of ubretinal fluid increaed with increaing patient age (P = .0493), thu uggeting an age-dependent decline in the pumping ability of the retinal pigment epithelium. Concluion Our data are conitent with a hydrodynamic model in which macular hole anatomy i determined by a balance between fluid flow through the hole and fluid outflow acro the retinal pigment epithelium. Becaue tage 3 and tage 4 macular hole exhibit a imilar relationhip between the ize of the macular hole and the ize of the cuff of ubretinal fluid around the hole, imple relief of vitreomacular traction would not lead to reolution of the ubretinal fluid cuff unle it i accompanied by a reduction in hole diameter due to approximation of wound edge.