OCT of a 66-year-old woman with reduced vision shows a full-thickness macular defect measuring approximately 550 micrometers, a small hyperreflective operculum overlying the hole, and complete separation of the posterior hyaloid from the retinal surface with no vitreofoveal attachment. Using the Gass classification, this is:

• A Stage 1b macular hole
• B Stage 2 macular hole
• C Stage 4 macular hole ✓
• D Stage 3 macular hole

Explanation

Stage 4 denotes a full-thickness macular hole with complete posterior vitreous detachment, evidenced here by the separated hyaloid and free operculum. Stage 3 is a large full-thickness hole with persistent vitreofoveal adhesion, while stage 2 is a small eccentric hole with attached hyaloid. Stage 1 is an impending hole with foveal cystic change and no full-thickness defect. Complete hyaloid separation is the feature that upgrades this to stage 4.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.