Full-thickness Macular Hole Formation in Eyes with a Pre-existing Complete Posterior Vitreous Detachment

Background: Tangential macular traction by the posterior vitreous cortex has been widely accepted as the major causative factor in the development of idiopathic macular holes. Separation of the posterior cortical vitreous should relieve this vitreoretinal traction. Methods: The authors report five patients with idiopathic full-thickness macular hole formation that occurred in the presence of a well-documented pre-existing complete posterior vitreous detachment. Results: Of five eyes, three underwent pars plana vitrectomy and instillation of transforming growth factor-beta. No residual prefoveal cortical vitreous was present at the retinal surface at the time of surgery. Additionally, clinically identifiable epiretinal membranes were present in three of five eyes, but these epiretinal membranes were extremely thin, transparent, induced minimal traction, and did not warrant surgical peeling. Conclusion: It is likely that, in these five patients, some mechanism other than tangential traction by prefoveal vitreous cortex is responsible for idiopathic full-thickness macular hole formation.