Movement of the inner retina complex during the development of primary full-thickness macular holes: implications for hypotheses of pathogenesis

  • Wai H. WoonEmail author
  • Denis Greig
  • Mike D. Savage
  • Mark C. T. Wilson
  • Colin A. Grant
  • Bataung Mokete
  • Fiona Bishop
Retinal Disorders



The inner retinal complex is a well-defined layer in spectral-domain OCT scans of the retina. The central edge of this layer at the fovea provides anatomical landmarks that can be observed in serial OCT scans of developing full-thickness macular holes (FTMH). Measurement of the movement of these points may clarify the mechanism of FTMH formation.


This is a retrospective study of primary FTMH that had a sequence of two OCT scans showing progression of the hole. Measurements were made of the dimensions of the hole, including measurements using the central edge of the inner retinal complex (CEIRC) as markers. The inner retinal separation (distance between the CEIRC across the centre of the fovea) and the Height-IRS (average height of CEIRC above the retinal pigment epithelium) were measured.


Eighteen cases were identified in 17 patients. The average increase in the base diameter (368 microns) and the average increase in minimum linear dimension (187 microns) were much larger than the average increase in the inner retinal separation (73 microns). The average increase in Height-IRS was 103 microns.


The tangential separation of the outer retina to produce the macular hole is much larger than the tangential separation of the inner retinal layers. A model based on the histology of the Muller cells at the fovea is proposed to explain the findings of this study.


Full-thickness macular hole Muller cells Pathogenesis Bistable Vitreomacular traction 


Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Wai H. Woon
    • 1
    Email author
  • Denis Greig
    • 2
  • Mike D. Savage
    • 2
  • Mark C. T. Wilson
    • 2
  • Colin A. Grant
    • 3
  • Bataung Mokete
    • 1
  • Fiona Bishop
    • 1
  1. 1.Department of OphthalmologySt James’ HospitalLeedsUK
  2. 2.University of LeedsLeedsUK
  3. 3.University of BradfordBradfordUK

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