Macular Hole in Proliferative Diabetic Retinopathy with Fibrovascular Proliferation

A full-thickness macular hole (FTMH) most commonly appears in senile patients without apparent underlying disease. It may also occur after blunt ocular trauma or in the conditions of high myopia, rhegmatogenous retinal detachment (RD), or even macular dystrophy (Garcia-Arumi et al., Retina 17(5):372–377, 1997; Ho et al., Surv Ophthalmol 42(5):393–416, 1998; Kwok et al., Retina 20(5):439–444, 2000). Diabetic retinopathy (DR) is another disease entity that may be associated with macular hole (MH) (Yeh et al., Retina 29(3):355–361, 2009; Lai and Yang, Taiwan J Ophthalmol 5(2):85–89, 2015). An idiopathic FTMH may develop by oblique tractions from vitreomacular (VM) adhesion with visual field (VF) separation or from tangential epiretinal membrane (ERM)/thickened PH traction (Haouchine et al., Ophthalmology 108(1):15–22, 2001; Johnson, Curr Opin Ophthalmol 13(3):152–160, 2002; Hussain et al., Indian J Ophthalmol 51(4):353–355, 2003; Gass, Arch Ophthalmol 106(5):629–639, 1988; Tsai et al., Retina 36(9):1679–1687, 2016; Ang et al., Ophthalmologica 245(2):187–193, 2022; Uemura et al., Retina 43(2):215–221, 2023). In contrast, in eyes with proliferative diabetic retinopathy (PDR), a unique pro-proliferative microenvironment exists and promotes ERM and fibrovascular proliferation (FVP) formation, causing complex traction on the macula (Kase et al., Br J Ophthalmol 91(10):1376–1378, 2007; Iannetti et al. Invest Ophthalmol Vis Sci 52(8):5786–5789, 2011; Abu El-Asrar et al., Mol Vis 16:1098–1107, 2010; Abu El-Asrar et al., Clin Exp Ophthalmol 38(1):57–64, quiz 87, 2010). The development, configuration, and surgical results of FTMHs in PDR may differ from those in other conditions. However, there is little research on the mechanisms, features, and treatment methods of FTMH in PDR. In this chapter, these issues will be discussed.