Asymptomatic Myopic Macular Hole
Secondary macular hole (MH) can occur in eyes with high myopia and the characteristics and demographics of these MHs differ from those of most idiopathic holes. Myopic MHs tend to develop in younger subjects and may be associated with a rhegmatogenous retinal detachment surrounding the hole.1 The mean age of patients in most myopic MH series is mid-fifties, whereas the mean age in idiopathic MH series is the upper sixties. The earlier onset of myopic MHs may be related to abnormal vitreomacular traction in myopic eyes, premature vitreous liquefaction, or other unknown factors predisposing these eyes to premature MHs – there is a predominance in women. The diagnosis may be difficult because of retinal pigment epithelium (RPE) and choroidal atrophy. Biomicroscopic diagnosis of MH in highly myopic eyes without retinal detachment is sometimes difficult. This could be due to a lack of contrast between the MH and RPE, particularly in the presence of a deep posterior staphyloma and severe chorioretinal atrophy. In asymptomatic myopic eyes with good vision, optical coherence tomography (OCT) has revealed the presence of MH.2 Asymptomatic MH is more prevalent in eyes with higher degrees of myopia and pronounced posterior staphyloma. In the authors’ experience of macular examination with optical coherence tomography in severely myopic eyes with posterior staphyloma, the authors have found that retinal detachment, retinoschisis, or both, are often seen at the fovea, suggesting that foveal retinal detachment may precede the onset of MH formation. Also, in these patients apparent complete posterior vitreous detachment (PVD) confirmed by biomicroscopy does not prevent vitreous remnants adhering to theretina, since vitreoschisis and a posterior vitreous cortex adherence has been found to persist. It may also be preceded by a foveal detachmentcausing the fovea to become extremely thin.
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