Purpose: Theoretically, idiopathic macular holes develop because of tangential vitreous traction on the fovea. The purpose of this study was to demonstrate ultrasonographically the vitreomacular relationships in a series of 44 consecutive patients with macular holes and to correlate the ultrasonographic findings with the clinical and intraoperative findings of these patients.
Methods: I examined 47 eyes with a macular holes by using contact lens biomicroscopy and clinically staged the macular hole and the status of the vitreous. A kinetic B-scan ultrasonographic examination of the vitreomacular relationships was performed in each study eye and in the fellow eye by using a contact method, with topical anesthesia.
Results: The clinical stage of macular hole in 47 eyes of 44 patients included eight holes in stage 1, five in stage 2, 22 in stage 3, and 12 in stage 4. The vitreous was attached to the macular region by ultrasound interpretation in seven of eight stage 1 holes, two of five stage 2 holes, 21 of 22 stage 3 holes, and zero of 12 stage 4 holes. The correlation between the clinical status of the vitreous and the ultrasonographic findings was high (94%). The status of the vitreous by ultrasound was confirmed intraoperatively in all 14 patients undergoing subsequent surgery.
Conclusions: Ultrasonographic examination of the vitreomacular relationships provides an accurate assessment of vitreomacular attachment or detachment. The ultrasonographic findings in these 47 eyes with macular holes support the vitreomacular traction theory of macular holes.