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    New theory may address idiopathic macular holes

    Evaluation of OCT images supports hypothesis of combined traction, hydration

    Take-home message: The evaluation of multiple optical coherence tomography images supports the combined tractional-hydration theory of idiopathic macular hole formation, progression, and closure.


    New York—The development of idiopathic macular holes can be divided into three distinct phases and one pivotal event involving both tractional and hydration forces, according to Ronald C. Gentile, MD.

    The exact pathogenesis of macular holes has long puzzled researchers. Theories have included inner retinal degeneration, glial migration, tangential and anterior-posterior (A-P) traction, hydrodynamics, and hydration, said Dr. Gentile, professor of ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York.

    In studying serial optical coherence tomography (OCT) images and clinical data on 115 eyes over 15 years, Dr. Gentile and his colleagues have found clues that macular holes require a traction mediated pivotal event and that hydration and tractional forces promoting hole progression are counteracted by the dehydration forces of the retinal pigment epithelium (RPE) pump. The force that prevails will determine whether a macular hole develops.

    Cystoid dehydration

    The researchers also propose a concept called cystoid dehydration as a mechanism to promote macular hole closure. They described examples in which cystoid dehydration can successfully close macular holes and result in external limiting membrane (ELM) repair.

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