Traction-induced foveal damage predisposes eyes with pre-existing posterior vitreous detachment to idiopathic macular hole formation

Aim To propose a new mechanism for the development of idiopathic macular hole in the setting of pre-existing posterior vitreous detachment (PVD). Methods Patients were examined clinically with fundus contact lens biomicroscopy and high-definition optical coherence tomography (OCT) was used to characterize the structural changes in the fovea following PVD. Results Two patients presented with vitreofoveal separation and were found by high-definition OCT to have subtle foveal disruption and irregularity of the foveal contour with no evidence of a full thickness macular hole. Sequential examination of these patients demonstrated delayed formation of idiopathic macular hole. Conclusion Traction-induced inner foveal damage occurring before or coincident with spontaneous vitreofoveal separation destabilizes the fovea and predisposes some eyes to delayed macular hole formation. Eye (2012) 26, 792-795; doi:10.1038/eye.2012.21; published online 2 March 2012