Macular microholes

PURPOSE: To describe the clinical features and natural course of microholes of the macula. METHODS: We reviewed the charts of 31 patients (35 eyes) with punctate foveal defects, or "microholes," of the macula. Patients were seen between 1980 and 2005 at a tertiary referral center. Clinical, photographic, and optical coherence tomography findings were reviewed. RESULTS: All eyes had one or more well defined, punctate foveal lesions 35 μm to 150 μm in size. There was no gender predilection, and patient ages ranged from 6 years to 69 years. Visual acuity was ≥20/40 in 29 of 35 eyes. None of the eyes had foveal transmission defects shown by fluorescein angiography. A defect in the outer retina was demonstrated in five of seven patients who underwent optical coherence tomography. The lesions were nonprogressive, with no patients developing stage 3 or 4 macular holes. CONCLUSION: Macular microholes are small lamellar defects in the outer retina or retinal pigment epithelium that occur through a variety of mechanisms, including spontaneous vitreoretinal interface changes, trauma, phototoxicity, and other unrecognized causes. The condition is nonprogressive, occurs in patients of all ages, and is compatible with good visual acuity.