How would you classify this condition? Answer Using the Gass classification, macular hole can be divided into four stages: Stage 1. This is so-called impending macular hole. The visual symptoms are minimal but the patient may complains of metamorphosia. Watzke's sign is negative. Stage 1 can be further divided into stage 1a in which there is yellow spot in the macula and stage 1b in which yellow ring is seen in the macula. About half of stage 1 progresses to stage 2. Stage 2 or early macular hole. There is small macular hole with variable visual loss. Stage 3. Fully developed macular hole with surrounding rim of subretinal fluid. There is a localised posterior vitreous detachment with overlying operculum. Yellowish deposits resembling drusen can be seen at the base of the hole. Watzke's sign is positive. Stage 4. It is similar to stage 3 except for the presence of complete posterior vitreous detachment. What stage does the imaging show? Answer Stage 3 macular hole How would you decide whether to carry out operation on this patient? Answer Macular hole surgery requires par plana vitrectomy and gas-fluid exchange and posturing. It is therefore a major operation. The factors that will affect the management depends on several factors: Health status of the patient Duration fo visual loss. Stage 4 macular hole of longer than 1 year is unlikely to improve significantly following surgery. Visual requirement of the patient. Following operation on this patient, the patient still has poor vision. What are the likely causes? Answer This may be caused by failure of closure of the macular hole or the development of retinal detachment. In addition, a significant cause of poor vision in those with successful operation is the development of cataract.
How would you classify this condition?
What stage does the imaging show?
How would you decide whether to carry out operation on this patient?
Following operation on this patient, the patient still has poor vision. What are the likely causes?
