Idiopathic macular hole following vitrectomy: Implications for pathogenesis

W. J. Lipham, W. E. Smiddy

Research output: Contribution to journalArticlepeer-review


Purpose: The pathogenesis of idiopathic macular holes has been commonly thought to be mediated by vitreous traction. A comprehensive classification system proposed by Gass was consistent with this hypothesis. While subsequent clinical and histopathological observations have led to revision of the classification system, the role of vitreomacular traction has remained unchallenged. The purpose of this study is to report three cases of idiopathic macular hole formation after vitrectomy that suggest an etiologic mechanism not mediated by vitreomacular traction. Methods: Retrospective case series report: three patients presented with a macular hole that developed several years after previous vitrectomy. In each case, there was no cortical vitreous element remaining in the region of the macula at the time of the operation for the macular hole. Results: The macular hole was successfully sealed in all patients. Conclusions: The cases in this report have important pathogenic implications. They lacked an operculum and occurred long after vitreous removal. There was no sign of cortical vitreous. Vitreofoveal traction, therefore, could not have played a role in macular hole formation in these cases. We conclude that these observations are consistent with macular hole formation via a degenerative process, independent of vitreomacular traction. In addition, we suggest that even typical cases may represent a process of foveolar degeneration that occurs prior to, or in association with, posterior cortical vitreous separation or vitreomacular traction.

Original languageEnglish (US)
Pages (from-to)S473
JournalInvestigative Ophthalmology and Visual Science
Issue number3
StatePublished - Feb 15 1996

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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