The Histopathologic and Clinical Features of Idiopathic Macular Hole

ABSTRACT

PURPOSE: The purpose of this study was to assess surgical results of internal limiting membrane maculorrhexis and to better understand the ultrastructural features of excised tissue during surgery for idiopathic macular holes. METHODS: We studied 10 patients (10 eyes) with idiopathic macular hole, who had undergone trans-pars planar vitrectomy, peeling of internal limiting membrane with maculorrhexis maneuver, air-fluid exchange, and intravitreal gas tamponade. During the vitrectomy surgery for idiopathic macular hole, we excised specimens. These surgical specimens were evaluated with transmission electron microscopy for their histopathologic features. RESULTS: We achieved complete hole closure in all 10 eyes, postoperatively. Sixty percent of the patients achieved visual improvement of 2 or more lines on Snellen E visual acuity chart. In the ultrasutuctural findings, internal limiting membranes were noted. Some of them showed cellular components enmeshed in a collagenous matrix. In many cases, we could find that the internal limiting membranes were covered on its inner surface by a layer of cells. The most frequent cell type was myofibroblasts, followed by fibrocytes and fibrous astrocytes. CONCLUSIONS: Our study supports the hypothesis that idiopathic macular holes occur because of histopathologic changes of the prefoveal internal limiting membranes. And we postulate that intentional removal of internal limiting membrane with maculorrhexis is a logically reasonable surgical treatment for idiopathic macular holes.