Skip to main content

Advertisement

Log in

Macular microhole and foveal red spot syndrome: a critical review of the literature

  • Review Article
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this article is to review the literature on nomenclature, natural history, clinical features, diagnosis, management, and prognosis of both macular microhole (MMH) and foveal red spot syndrome (FRS).

Methods

A PubMed primary literature search (February 1, 2020) utilizing the terms macular microhole, foveal red spot syndrome, and outer retinal hole was conducted. All chosen articles were case reports or case series. Articles qualified for inclusion if they documented symptoms, imaging findings, or followed patients longitudinally.

Results

A total of 14 studies from 1988 to 2019 that evaluated either MMH, FRS, or both were included in the review. No comparative study between the two defects was found. Studies often used the terms FRS and MMH interchangeably to reference both partial- and full-thickness lesions of the macula. Spectral-domain optical coherence tomography (SD-OCT) was most frequently able to identify these lesions and revealed an absence of all neural retinal layers from the inner limiting membrane (ILM) to the retinal pigment epithelium (RPE) in the full-thickness lesions while the partial-thickness lesions most often involved the photoreceptor layer (PRL) and less frequently the external limiting membrane (ELM). OCT revealed that vitreomacular traction (VMT) was involved in the natural history of both FRS and MMH for a significant subset of patients.

Conclusion

The terms MMH and FRS have been used interchangeably in the literature. Advances in OCT have revealed that MMHs and FRSs are distinct but sometimes overlapping entities. We suggest that MMH and FRS are similar entities defined as one or more sharply defined lesions in the fovea of the eye < 150 μm in size. MMHs are a full-thickness defect of the entire neuroretina at the center of the foveola while FRSs are partial-thickness lesions. Current literature suggests that there may be subtle differences in the pathogenesis, clinical features, and diagnosis between MMH and FRS; however, prognosis and management for both are favorable. Lastly, we suggest that the terms outer lamellar macular microholes and full-thickness macular microholes may be the more appropriate terminologies to refer to FRS and MMH, respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

All data was obtained and accessed utilizing PubMed.

References

  1. Cairns JD, McCombe MF (1988) Microholes of the fovea centralis. Aust N Z J Ophthalmol 16(2):75–79. https://doi.org/10.1111/j.1442-9071.1988.tb01253.x

    Article  CAS  PubMed  Google Scholar 

  2. Ritchey CL, Ewald RA (1970) Sun gazing as the cause of foveomacular retinitis. Am J Ophthalmol 70(4):491–497. https://doi.org/10.1016/0002-9394(70)90881-0

    Article  CAS  PubMed  Google Scholar 

  3. Grey RH (1978) Foveo-macular retinitis, solar retinopathy, and trauma. Br J Ophthalmol 62(8):543–546. https://doi.org/10.1136/bjo.62.8.543

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Emerson GG, Spencer GR, Klein ML (2007) Macular microholes. Retina (Philadelphia, Pa) 27(5):595–600. https://doi.org/10.1097/01.iae.0000243068.68099.b4

    Article  Google Scholar 

  5. Douglas RS, Duncan J, Brucker A, Prenner JL, Brucker AJ (2003) Foveal spot: a report of thirteen patients. Retina (Philadelphia, Pa) 23(3):348–353. https://doi.org/10.1097/00006982-200306000-00010

    Article  Google Scholar 

  6. Kostanyan T, Wollstein G, Schuman JS (2015) New developments in optical coherence tomography. Curr Opin Ophthalmol 26(2):110–115. https://doi.org/10.1097/ICU.0000000000000133

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wolf S, Wolf-Schnurrbusch U (2010) Spectral-domain optical coherence tomography use in macular diseases: a review. Ophthalmologica 224(6):333–340

    Article  Google Scholar 

  8. Reddy CV, Folk JC, Feist RM (1996) Microholes of the macula. Arch Ophthalmol 114(4):413–416. https://doi.org/10.1001/archopht.1996.01100130409007

    Article  CAS  PubMed  Google Scholar 

  9. Zambarakji HJ, Schlottmann P, Tanner V, Assi A, Gregor ZJ (2005) Macular microholes: pathogenesis and natural history. Br J Ophthalmol 89(2):189–193. https://doi.org/10.1136/bjo.2004.052084

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Johnson MW (2010) Posterior vitreous detachment: evolution and complications of its early stages. Am J Ophthalmol 149(3):371–82.e1. https://doi.org/10.1016/j.ajo.2009.11.022

    Article  PubMed  Google Scholar 

  11. Vaishnavi BP, Nair U, Soman M, Nair KG (2014) Spectral domain optical coherence tomography study of macular microhole morphology and its correlation with vitreomacular interface abnormalities. Int Ophthalmol 34(3):493–499. https://doi.org/10.1007/s10792-013-9837-0

    Article  PubMed  Google Scholar 

  12. Ooto S, Hangai M, Takayama K, Ueda-Arakawa N, Makiyama Y, Hanebuchi M, Yoshimura N (2014) High-resolution imaging of photoreceptors in macular microholes. Invest Ophthalmol Vis Sci 55(9):5932–5943. https://doi.org/10.1167/iovs.13-13792

    Article  PubMed  Google Scholar 

  13. Gella L, Raman R, Pal SS, Nittala MG, Sharma T (2012) Morphological and functional changes in spectral domain optical coherence tomography and microperimetry in macular microhole variants: spectral domain optical coherence tomography and microperimetry correlation. Indian J Ophthalmol 60(1):53–56

    Article  Google Scholar 

  14. Comander J, Gardiner M, Loewenstein J (2011) High-resolution optical coherence tomography findings in solar maculopathy and the differential diagnosis of outer retinal holes. Am J Ophthalmol 152(3):413–419.e6. https://doi.org/10.1016/j.ajo.2011.02.012

    Article  PubMed  Google Scholar 

  15. Gaudric A (2008) Macular cysts, holes and cavitations : 2006 Jules Gonin lecture of the Retina Research Foundation. Graefe's Arch Clin Exp Ophthalmol 246(7):1071–1079. https://doi.org/10.1007/s00417-008-0818-3

    Article  CAS  Google Scholar 

  16. Johnson MW (2005) Perifoveal vitreous detachment and its macular complications. Trans Am Ophthalmol Soc 103:537–567

    PubMed  PubMed Central  Google Scholar 

  17. Lai MM, Bressler SB, Haller JA (2006) Spontaneous resolution of macular microhole. Am J Ophthalmol 141(1):210–212. https://doi.org/10.1016/j.ajo.2005.07.074

    Article  PubMed  Google Scholar 

  18. Caramoy A, Fauser S, Kirchhof B (2011). Spontaneous progression of a full-thickness macular microhole to a lamellar macular hole in spectral domain optical coherence tomography. GMS Ophthalmol Cases 1:Doc02

  19. Yu S, Bellone D, Lee SE, Yannuzzi LA (2015) Multimodal imaging in foveal red spot syndrome. Retin Cases Brief Rep 9(2):97–101. https://doi.org/10.1097/ICB.0000000000000123

    Article  PubMed  Google Scholar 

  20. Fukumoto M, Morishita S, Okuda Y, Suzuki H, Sato T, Kida T, Ikeda T (2015) A case of a vitreomacular traction-associated macular microhole in an eye with focal choroidal excavation. Case Rep Ophthalmol 6(1):71–75. https://doi.org/10.1159/000377667

    Article  PubMed  PubMed Central  Google Scholar 

  21. Yıldırım Ş, Menteş J, Barış M (2019) Vitreomacular traction and outer retinal structural changes. Turk J Ophthalmol 49(2):109–113. https://doi.org/10.4274/tjo.galenos.2018.79577

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ritchey CL, Ewald RA (1970) Sun gazing as the cause of foveomacular retinitis. Am J Ophthalmol 70(4):491–497. https://doi.org/10.1016/0002-9394(70)90881-0

    Article  CAS  PubMed  Google Scholar 

  23. Takahashi A, Ishiko S, Nagaoka T, Kato Y, Kameyama D, Yoshida A (2010) Macular microhole of the outer retinal defect with a perifoveal posterior vitreous detachment. Ophthalmic Surg, Lasers Imaging 1–4. Advance online publication. https://doi.org/10.3928/15428877-20100215-24

  24. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, Sadda SR, Sebag J, Spaide RF, Stalmans P (2013) The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 120(12):2611–2619. https://doi.org/10.1016/j.ophtha.2013.07.042

    Article  PubMed  Google Scholar 

  25. Kelley JS, Hoover RE, George T (1978) Whiplash maculopathy. Arch Ophthalmol 96(5):834–835. https://doi.org/10.1001/archopht.1978.03910050440007

    Article  CAS  PubMed  Google Scholar 

  26. Kuhn F, Morris R, Mester V, Witherspoon CD (2001) Internal limiting membrane removal for traumatic macular holes. Ophthalmic Surg Lasers 32(4):308–315

    Article  CAS  Google Scholar 

  27. Pham TQ, Chua B, Gorbatov M, Mitchell P (2007) Optical coherence tomography findings of acute traumatic maculopathy following motor vehicle accident. Am J Ophthalmol 143(2):348–350. https://doi.org/10.1016/j.ajo.2006.09.024

    Article  PubMed  Google Scholar 

  28. Bringmann A, Duncker T, Jochmann C, Barth T, Duncker G, Wiedemann P (2020) Spontaneous closure of small full-thickness macular holes: presumed role of Müller cells. Acta Ophthalmol 98(4):e447–e456. https://doi.org/10.1111/aos.14289

    Article  PubMed  Google Scholar 

  29. Gass JD (1999) Müller cell cone, an overlooked part of the anatomy of the fovea centralis: hypotheses concerning its role in the pathogenesis of macular hole and foveomacualr retinoschisis. Arch Ophthalmol 117(6):821–823. https://doi.org/10.1001/archopht.117.6.821

    Article  CAS  PubMed  Google Scholar 

  30. Bikbova G, Oshitari T, Baba T, Yamamoto S, Mori K (2019) Pathogenesis and management of macular hole: review of current advances. J Ophthalmol 2019:3467381. https://doi.org/10.1155/2019/3467381

    Article  PubMed  PubMed Central  Google Scholar 

  31. la Cour M, Friis J (2002) Macular holes: classification, epidemiology, natural history and treatment. Acta Ophthalmol Scand 80(6):579–587. https://doi.org/10.1034/j.1600-0420.2002.800605.x

    Article  PubMed  Google Scholar 

  32. Gass JD (1995) Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol 119(6):752–759. https://doi.org/10.1016/s0002-9394(14)72781-3

    Article  CAS  PubMed  Google Scholar 

  33. Wu CY, Jansen ME, Andrade J, Chui T, Do AT, Rosen RB, Deobhakta A (2018) Acute solar retinopathy imaged with adaptive optics, optical coherence tomography angiography, and en face optical coherence tomography. JAMA Ophthalmol 136(1):82–85. https://doi.org/10.1001/jamaophthalmol.2017.5517

    Article  PubMed  Google Scholar 

  34. Tabatabaei SA, Soleimani M, Bohrani B, Banafsheafshan A, Faghihi S, Faghihi H (2019) Multimodal imaging in photic retinopathy. Int J Ophthalmol 12(3):523–525. https://doi.org/10.18240/ijo.2019.03.27

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kay CN, Pavan PR, Burrows A, Martino AZ (2010) Neurosensory retinal detachment of the macula in retinal phototoxicity documented by optical coherence tomography. Retin Cases Brief Rep 4(2):143–145. https://doi.org/10.1097/ICB.0b013e3181997ce7

    Article  PubMed  Google Scholar 

  36. Gaudric A, Ducos de Lahitte G, Cohen SY, Massin P, Haouchine B (2006) Optical coherence tomography in group 2A idiopathic juxtafoveolar retinal telangiectasis. Arch Ophthalmol 124(10):1410–1419. https://doi.org/10.1001/archopht.124.10.1410

    Article  PubMed  Google Scholar 

  37. Gomes NL, Greenstein VC, Carlson JN, Tsang SH, Smith RT, Carr RE, Hood DC, Chang S (2009) A comparison of fundus autofluorescence and retinal structure in patients with Stargardt disease. Invest Ophthalmol Vis Sci 50(8):3953–3959. https://doi.org/10.1167/iovs.08-2657

    Article  PubMed  Google Scholar 

  38. Bourla DH, Sarraf D, Schwartz SD (2007) Peripheral retinopathy and maculopathy in high-dose tamoxifen therapy. Am J Ophthalmol 144(1):126–128. https://doi.org/10.1016/j.ajo.2007.03.023

    Article  CAS  PubMed  Google Scholar 

  39. Trichonas G, Kaiser PK (2014) Optical coherence tomography imaging of macular oedema. Br J Ophthalmol 98(Suppl 2):ii24–ii29. https://doi.org/10.1136/bjophthalmol-2014-305305

    Article  PubMed  Google Scholar 

  40. Otani T, Kishi S, Maruyama Y (1999) Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol 127(6):688–693. https://doi.org/10.1016/s0002-9394(99)00033-1

    Article  CAS  PubMed  Google Scholar 

  41. Zysk AM, Nguyen FT, Oldenburg AL, Marks DL, Boppart SA (2007) Optical coherence tomography: a review of clinical development from bench to bedside. J Biomed Opt 12(5):051403. https://doi.org/10.1117/1.2793736

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Publication of this article was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq; Brasília, Brazil) and Pan-American Association of Ophthalmology/Pan-American Ophthalmological Foundation, Paul Kayser/RRF Retina Research Foundation Global Award (PAAO/PAOF; Arlington, Texas).

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. The first draft of the manuscript was written by James Garcia, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to James H. Garcia.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Code availability

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of a topical collection on Macular Hole

The primary literature search was conducted at St. Louis University Hospital in the department of ophthalmology.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garcia, J.H., Johnson, M., Shah, G. et al. Macular microhole and foveal red spot syndrome: a critical review of the literature. Graefes Arch Clin Exp Ophthalmol 259, 1685–1694 (2021). https://doi.org/10.1007/s00417-020-04995-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04995-z

Keywords

Navigation