A 28-year-old myopic man presents with a 1-week history of a central scotoma and distortion in the left eye. OCT shows a full-thickness defect of 400 microns in diameter with cuff of subretinal fluid and no vitreomacular traction. The posterior hyaloid is detached from the macula. According to the International Vitracular Traction Study classification, what is the stage of this macular hole?

• A Stage 1 impending macular hole
• B Stage 2 small full-thickness macular hole
• C Stage 4 full-thickness macular hole with complete posterior vitreous detachment ✓
• D Stage 3 full-thickness macular hole with vitreomacular traction

Explanation

Stage 4 macular hole is defined as a full-thickness defect with a complete posterior vitreous detachment (Weiss ring present). Stage 3 has persistent vitreomacular traction. Stage 2 is a small (<400 micron) full-thickness hole. Stage 1 is impending (foveal pseudocyst or yellow spot). The absence of vitreomacular traction with PVD indicates Stage 4.

Reference: Ryan's Retina, 6th ed.

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