Macular hole
The macula contains a full thickness hole which is about a quarter of a disc diameter. There may 
be an operculum seen in the vitreous. Note: If the macula shows wrinkling, make sure that you 
are not looking at a pseudohole which may occur in cellophane maculopathy. Examine the other 
eye for similar lesion as macular hole is bilateral in about 15% of cases. 

Further examination:

  • when examine the other eye look specifically for the presence of  posterior vitreous 

  • detachment (in the absence of macular hole, the presence of total posterior  vitreous 
    detachment means that the risk of future macular hole is low)
  • perform a Watzke test. A thin long beam of light is projected through a 78 or 90D 

  • onto the macular hole and the patient is asked if there is a gap in the light. The presence 
    of a gap is termed positive Watzke's test and occurs in full thickness macular hole.


1. What are the causes of macular hole?

2. What are the stages of macular hole?

3. How would you manage a patient with stage 1 macular hole?

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