الفهرس 
ANATOMY OF THE MACULAOnly 14 pages are availabe for public view
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Abstract
The macula is the central part of the retina which responsible for the sharp detailed central vision. The macular hole a partial or full thickness defect involving the anatomic fovea.
The most of the full-thickness macular holes are idiopathic, but it may rarely occur due to other causes like trauma, pathological myopia, laser and degenerative conditions of the retina.
In 1988 Gass has described an updated biomicroscopic classification of idiopathic macular hole into 4 stages and postulated that tangential vitreous traction may play a role in macular hole formation.
Idiopathic macular holes commonly affect people in the seventh decade of life. The clinical manifestations of the disease includes: defective vision, distortion of images (Metamorphopsia) and central loss of vision (Central scotoma). While patients with small holes may have no symptoms and are discovered accidentally during routine examinations.
The diagnosis of macular hole is made in most cases by the clinical evaluation which includes (Assessment of the visual acuity – Fundus ophthalmoscopic examination – Amsler gird), but many investigations can be done to confirm the diagnosis which includes: Watzke and Laser aiming beam, Fundus photography, Fluorecscein angiography, Ultrasonography, Macular perimetery using Scanning laser ophthalmoscope and The Optical Coherence Tomography which is the most important and recent imaging technique in the diagnosis, pathogenesis, staging and management of the macular hole.
The management of the idiopathic macular hole includes:
1- Laser Treatment.
2- Surgical Treatment:
• In 1991 Kelly and Wendel introduce the use of pars-planna vitrectomy for macular hole management. The goal of surgery is to relive the antro-posterior or tangential vitreo-retinal traction.
• Recent studies suggest that peeling of the internal limiting membrane increase the success rate of macular hole surgery.
• In the last years, using Transforming growth factor and autologus serum helps wound healing in macular hole.
• The most recent studies and trials show promise in using the Stem cells in macular hole management by using the patient own bone marrow.