Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Retina. 2019 Jul;39(7):1236-1264. doi: 10.1097/IAE.0000000000002448.
To study the etiology, clinical features, management options, and visual prognosis in various types of atypical macular holes (MHs).
A review of the literature was performed, which focused on the etiopathogenesis of atypical or secondary MHs, their differentiating clinical features, management strategies, and varied clinical outcomes. Idiopathic or age-related, myopic, and traumatic MHs were excluded.
Atypical or secondary MHs arise out of concurrent ocular pathologies (dystrophy, degeneration, or infections) and laser/surgery. The contributing factors may be similar to those responsible for idiopathic or typical MHs, i.e., tangential or anteroposterior vitreofoveal traction or cystoid degeneration. The management is either observation or treatment of the underlying cause. The prognosis depends on the background pathology, duration of disease, and baseline visual acuity governed by the size of MH and morphologic health of underlying RPE and photoreceptors. The closer the morphology of atypical MH is to that of an idiopathic MH, the better the surgical outcome is.
With the advancements in retinal imaging, atypical MHs are now more frequently recognized. With increasing understanding of the underlying disease processes, and improvement in investigations and surgical treatment, management of atypical MHs may improve in the future.
研究各种非典型性黄斑裂孔（MH）的病因、临床特征、处理选择和视力预后。
对文献进行了回顾，重点关注非典型或继发性 MH 的病因发病机制、其鉴别临床特征、治疗策略和不同的临床结果。排除特发性或年龄相关性、近视性和外伤性 MH。
非典型或继发性 MH 由并存的眼部病变（营养不良、变性或感染）和激光/手术引起。致病因素可能与特发性或典型 MH 相同，即切线或前后玻璃体黄斑牵引或囊样变性。治疗方法为观察或治疗基础病因。预后取决于背景病理学、疾病持续时间以及 MH 的大小和底层 RPE 和光感受器的形态健康决定的基线视力。非典型 MH 的形态越接近特发性 MH，手术效果越好。
随着视网膜成像技术的进步，现在越来越多地发现非典型 MH。随着对潜在疾病过程的理解不断加深，以及检查和手术治疗的改善，非典型 MH 的治疗未来可能会得到改善。
