Mapping posterior vitreous detachment by optical coherence tomography in eyes with idiopathic macular hole

Purpose: To determine the relationship between posterior vitreous detachment and idiopathic macular hole. Design: Observational case series. Methods: In a prospective study, the posterior hyaloid face was scanned from the posterior pole to the far periphery by optical coherence tomography in 25 eyes (22 patients) with an idiopathic macular hole (stage 1 = 1, stage 2 = 7, stage 3 = 10, and stage 4 = 7), and a map of the posterior vitreous detachment was constructed. Results: One eye with a stage 1 macular hole had a posterior vitreous detachment confined to the vascular arcade, but attached to the fovea. In all seven eyes at stage 2, the detached posterior hyaloid enlarged upward beyond the superior vascular arcade, but stopped at the margin of inferior vascular arcade. In two cases, the posterior vitreous detachment also extended temporally and superonasally. In all cases, the vitreous face remained attached to the fovea. Six of the 10 eyes at stage 3 had larger partial posterior vitreous detachment that extended not only upward, but also beyond the inferior vascular arcade, while in the other four eyes, the size and position of the posterior vitreous detachment was similar to stage 2 macular holes. However, unlike stage 2, the posterior vitreous detachment included the fovea in all eyes. All seven eyes with a stage 4 macular hole had complete posterior vitreous detachment that extended to the far periphery in all directions. Conclusions: There is a close correlation between the stage of the macular hole and the degree of posterior vitreous detachment. This close correlation suggests that progression of idiopathic macular hole is related to enlargement of the posterior vitreous detachment.