1. Macular Hole F.Fazel:MD

3. Pathophysiology of MH Age-related primary idiopathic Trauma
Laser treatment
Cystoid macular edema
Inflammation
Retinal vascular disease
Retinal detachment
Age-related primary idiopathic

4. Idiopathic MH Seven decade Predominantly female(67%-91%)
Younger age in myopes
1%-25% bilatera

5. Pathophysiology Anteroposterior transvitreal traction????...
Tangential traction of cortical vitreous

8. Staging

9. Staging 1:impendiing MH(foveal &foveolar detached)
2:small fullthicknes MH)<400M)
3:fullthickness MH(>400M)
4:Complete PVD

10. Signs & symptoms stage 1 Mild Central visual loss &metamorphopsia
Loss of foveal depression
Yellow spot or yellow ring
50% resolved spontaneously
50% progress to stage 2

11. Signs & sympoms stage 2-3 Full thikness hole Vision loss
Annular neurosensory detachment
Absolute scotoma((watzke-allen sign)

12. Sign & symptoms stage4
Complete PVD (weiss ring)

13. Fluorescein Angiography
Circular transmission defect(stage 2-3-4)
Loss of xanthophyll & RPE atrophy

16. OCT
IS GOLD STANDARD IN DIAGNOSIS AND STAGING

17. Stage 1

18. Stage 2

19. Stage 3

20. Stage 4

21. Management Stage 1:fallow up
Stage 2-4:vitrectomy +gas injection(90%-100% hole closure)