Ординатура / Офтальмология / Английские материалы / Illustrated Tutorials in Ophthalmology Kanski, Bolton 2001
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Clinical features of full-thickness macular hole
•Typically affects elderly females
•Eventually bilateral in 10%
•VA about 6/60
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Round punched-out area at fovea |
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Multiple yellow deposits within crater |
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Surrounding halo of sub-retinal fluid |
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Positive Watzke-Allen sign |
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FA of full-thickness macular hole
Hyperfluorescence due to RPE ‘window defect’
Treatment of Macular Hole
1.Indications
•Full-thickness macular hole
•Visual acuity < 6/18
•Duration < 1 year
2.Technique
•Vitrectomy and fluid-gas exchange
3.Results
•Closure in about 60%
•40% regain 2 or more lines of VA
Idiopathic premacular fibrosis
Cellophane maculopathy |
Macular pucker |
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Translucent epiretinal |
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Severe retinal wrinkling and |
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Opaque epiretinal membrane |
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membrane |
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vascular distortion |
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Fine retinal striae and mild |
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Pucker emanating from |
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May be associated with |
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macular pseudo-hole |
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vascular distortion |
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epicentre |
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Important causes of CMO
Retinal vein occlusion |
Background diabetic retinopathy |
Post-cataract surgery |
Intermediate uveitis |
FA of cystoid macular oedema
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Early parafoveal leakage |
Coalescence of leaking points |
Late pooling with |
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‘flower-petal’ pattern |
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Treatment Options of CMO
1.No treatment
•Very mild - good VA
•Too early - wait for spontaneous improvement
•Too late - poor VA (lamellar hole)
•Treatment not beneficial - CRVO
2.Laser photocoagulation
•Diabetic retinopathy
•Branch retinal vein occlusion
3.Periocular steroids
•Intermediate uveitis
•Post cataract
4.Systemic carbonic anhydrase inhibitors
•Intermediate uveitis
•Post cataract
Myopic maculopathy
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Atrophic |
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‘Lacquer cracks’ |
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Progressive chorioretinal atrophy |
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Large breaks in Bruch membrane |
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May be associated with macular hole |
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Develop in about 5% of highly myopic eyes |
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Macular haemorrhage |
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Fuchs spot |
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From CNV with lacquer cracks |
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Secondary pigment proliferation |
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From lacquer cracks alone |
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Follows absorption of blood |
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