Traction-induced foveal damage predisposes eyes with pre-existing posterior vitreous detachment to idiopathic macular hole formation.

AIM: To propose a new mechanism for the development of idiopathic macular hole in the setting of pre-existing posterior vitreous detachment (PVD).

METHODS

Patients were examined clinically with fundus contact lens biomicroscopy and high-definition optical coherence tomography (OCT) was used to characterize the structural changes in the fovea following PVD.

RESULTS

Two patients presented with vitreofoveal separation and were found by high-definition OCT to have subtle foveal disruption and irregularity of the foveal contour with no evidence of a full thickness macular hole. Sequential examination of these patients demonstrated delayed formation of idiopathic macular hole.

CONCLUSION

Traction-induced inner foveal damage occurring before or coincident with spontaneous vitreofoveal separation destabilizes the fovea and predisposes some eyes to delayed macular hole formation.