Macular hole formation (full-thickness) is best explained by which pathomechanism according to current understanding?

• A Tangential and/or antero-posterior vitreous traction at the fovea resulting in dehiscence of the foveal photoreceptors ✓
• B Laser photocoagulation of the fovea causing tissue necrosis
• C RPE degeneration and photoreceptor loss from AMD-related atrophy
• D Retinal ischaemia from a foveal microaneurysm rupture

Explanation

Idiopathic macular hole formation is caused by tangential traction from a prefoveal posterior vitreous cortex (vitreoschisis) and/or antero-posterior traction as the vitreous incompletely separates from the fovea during posterior vitreous detachment (PVD). This traction dehisces the foveal photoreceptors centrally. OCT shows the stages from foveal detachment (stage 1) through pseudophole (stage 2) to full-thickness hole (stages 3 and 4). Pars plana vitrectomy with ILM peeling removes the traction-generating membrane and allows macular hole closure. RPE atrophy causes geographic atrophy in AMD, not macular hole.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.