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Michalewska Z et al. - The high prevalence of macular abnormalities in the fellow eyes particularly epiretinal membranes and vitreous traction with schizis as well as the evolution of these abnormalities over time suggest that diseases of the vitreomacular interface may have similar pathogenesis. Macular hole formation often starts as a triangular elevation of the photoreceptor layer. In some cases, a cyst in the inner retinal layers can be an early step in macular hole formation.

Exclusive Author Commentary
Dr Zofia Michalewska, 07/02/09

Tt seems very probable that vitreoretinal traction directed to the boundary of the Muller cell cone, produces traction from inner to outer layers of the retina which are possible both with and without cystic spaces in the inner retina and may produce the elevation of the photoreceptor layer progressing to full thickness defect. Additional traction and posterior hyaloid detachment produces ILM defects and some defects in the Muller cell cone. During this stage the vitreous may detach without any defects in retinal structure and self-sealing of the macular hole occurs.

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