[Macular holes. A treatable disease picture with unsolved problems].

Macular holes have a special position in the paradigmatic change of vitreoretinal surgery during the past 10 years. While the rationale for existence of retinal and vitreal surgery is based largely on invasive mechanical intervention in cases of large-surface epiretinal tractions, e.g., in diabetic traction amotio or detached retina with PVR, the intention of surgical treatment for macular holes is to employ a minimally invasive method, using less direct mechanical manipulation and taking into consideration physical and cell biological aspects to induce local repair processes. Whereas the classification according to Gass is still completely based on the perspective of epiretinal traction via retracted vitreal material, newer theories, relying on more subtle diagnostic examination techniques, assume a complex interaction of tractive and proliferative effects.