Clinical and morphological comparisons of idiopathic macular holes between stage 3 and stage 4

  • Yanping Yu
  • Xida Liang
  • Zengyi Wang
  • Jing Wang
  • Wu LiuEmail author
Retinal Disorders



To compare clinical and morphological differences in idiopathic macular holes (IMHs) between stage 3 and stage 4.


In this retrospective cross-sectional observational study, patients with stage 3 and stage 4 IMHs based on Gass’s classification in 1988 were enrolled. Horizontally and vertically, optical coherence tomography (OCT)-based parameters including minimum linear diameter (MLD), basal diameter (BD), and macular hole height (H) were measured; fluid cuff (FC), diameter hole index (DHI), macular hole index (MHI), traction hole index (THI), and hole form factor (HFF) were calculated. Afterwards, stage 3 IMHs smaller than 400 μm were excluded according to Gass’s classification in 1995. Clinical features, such as age, duration of symptoms, and baseline best-corrected visual acuity (BCVA), and OCT parameters were compared respectively between two stages based on both classifications.


Given classification of 1988, stage 3 IMHs had significantly shorter duration of symptoms (P = 0.020) and smaller horizontal BD (P = 0.041). Horizontally and vertically, MLD (P = 0.001, 0.004 respectively), DHI (P = 0.032, 0.021 respectively), and HFF (P = 0.032, 0.017 respectively) were significantly smaller and THI (P = 0.011, 0.020 respectively) was significantly larger in stage 3 holes. Clinical features like age and baseline BCVA showed no significant differences. When staged by classification of 1995, IMHs of the two stages shared similar features.


Stage 3 IMHs, instead of owning shorter duration of symptoms and smaller diameters, share similar clinical and morphological features with stage 4 IMHs according to Gass’s classification in 1995, which excludes IMHs smaller than 400 μm from stage 3 compared to his 1988 version.


Idiopathic macular hole Stage Optical coherence tomography Morphology 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Benson WE, Cruickshanks KC, Fong DS et al (2001) Surgical management of idiopathic macular holes. Ophthalmology 108(7):1328–1335CrossRefGoogle Scholar
  2. 2.
    Steel DHW, Lotery AJ (2013) Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye 27:S1–S21CrossRefGoogle Scholar
  3. 3.
    Brockmann T, Steger C, Weger M et al (2013) Risk assessment of idiopathic macular holes undergoing vitrectomy with dye-assisted internal limiting membrane peeling. Retina 33(6):1132–1136CrossRefGoogle Scholar
  4. 4.
    McCannel CA, Ensminger JL, Diehl NN et al (2009) Population based incidence of macular holes. Ophthalmology 116(7):1366–1369CrossRefGoogle Scholar
  5. 5.
    Wang S, Xu L, Jonas JB (2006) Prevalence of full-thickness macular holes in urban and rural adult Chinese: the Beijing Eye Study. Am J Ophthalmol 141(3):589–591CrossRefGoogle Scholar
  6. 6.
    Ezra E, Wells JA, Gray RH et al (1998) Incidence of idiopathic full-thickness macular holes in fellow eyes. A 5-year prospective natural history study. Ophthalmology 105(2):353–3599CrossRefGoogle Scholar
  7. 7.
    Madi HA, Masri I, Steel DH (2016) Optimal management of idiopathic macular holes. Clin Ophthalmol 10(1):97–116PubMedPubMedCentralGoogle Scholar
  8. 8.
    Ezra E (2001) Idiopathic full thickness macular hole: natural history and pathogenesis. Br J Ophthalmol 85(1):102–108CrossRefGoogle Scholar
  9. 9.
    Gass JD (1998) Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol 106(5):629–639CrossRefGoogle Scholar
  10. 10.
    Gass JD (1995) Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol 119(6):752–759CrossRefGoogle Scholar
  11. 11.
    Duker JS, Kaiser PK, Binder S et al (2013) The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 120(12):2611–2619CrossRefGoogle Scholar
  12. 12.
    Williamson TH, Lee E (2014) Idiopathic macular hole: analysis of visual outcomes and the use of indocyanine green or brilliant blue for internal limiting membrane peel. Graefes Arch Clin Exp Ophthalmol 252(3):395–400CrossRefGoogle Scholar
  13. 13.
    Kusuhara S, Negi A (2014) Predicting visual outcome following surgery for idiopathic macular holes. Ophthalmologica 231(3):125–132CrossRefGoogle Scholar
  14. 14.
    Shen PY, Xian WG, Liu HS et al (2017) Outcomes of 25-gauge vitrectomy with air tamponade for idiopathic macular hole repair surgery. Guoji Yanke Zazhi( Int Eye Sci) 17(7):1202–1208Google Scholar
  15. 15.
    He F, Dong FT, Yu WH et al (2015) Recovery of photoreceptor layer on spectral-domain optical coherence tomography after vitreous surgery combined with air tamponade in chronic idiopathic macular hole. Ophthalmic Surg Lasers Imaging Retina 46(1):44–48CrossRefGoogle Scholar
  16. 16.
    Parravano M, Giansanti F, Eandi CM et al (2015) Vitrectomy for idiopathic macular hole. Cochrane Database Syst Rev 12(5):CD009080Google Scholar
  17. 17.
    Hasegawa Y, Hata Y, Mochizuki Y et al (2009) Equivalent tamponade by room air as compared with SF6 after macular hole surgery. Graefes Arch Clin Exp Ophthalmol 247(11):1455–1459CrossRefGoogle Scholar
  18. 18.
    Wakely L, Rahman R, Stephenson J (2012) A comparison of several methods of macular hole measurement using optical coherence tomography, and their value in predicting anatomical and visual outcomes. Br J Ophthalmol 96(7):1003–1007CrossRefGoogle Scholar
  19. 19.
    Ullrich S, Haritoglou C, Gass C et al (2002) Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol 86(4):390–393CrossRefGoogle Scholar
  20. 20.
    Ruiz-Moreno JM, Staicu C, Pinero DP et al (2008) Optical coherence tomography predictive factors for macular hole surgery outcome. Br J Ophthalmol 92(5):640–644CrossRefGoogle Scholar
  21. 21.
    Kusuhara S, Teraoka EMF, Fujii S et al (2004) Prediction of postoperative visual outcome based on hole configuration by optical coherence tomography in eyes with idiopathic macular holes. Am J Ophthalmol 138(5):709–716CrossRefGoogle Scholar
  22. 22.
    Hikichi T, Yoshida A, Akiba J et al (1995) Natural outcomes of stage 1, 2, 3, and 4 idiopathic macular holes. Br J Ophthalmol 79(6):517–520CrossRefGoogle Scholar
  23. 23.
    Yun C, Oh J, Hwang SY et al (2012) Morphologic characteristics of chronic macular hole on optical coherence. Retina 32(10):2077–2084CrossRefGoogle Scholar
  24. 24.
    Ip MS, Baker BJ, Duker JS et al (2002) Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography. Arch Ophthalmol 120(1):29–35CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yanping Yu
    • 1
    • 2
  • Xida Liang
    • 1
    • 2
  • Zengyi Wang
    • 1
    • 2
  • Jing Wang
    • 1
    • 2
  • Wu Liu
    • 1
    • 2
    Email author
  1. 1.Beijing Tongren Eye Center, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
  2. 2.Beijing Ophthalmology and Visual Sciences Key LaboratoryBeijingChina

Personalised recommendations