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This brochure is a historical review of the subject of macular holes, their etiology and pathology. The author concludes that small holes, which are asymptomatic, occur frequently and seem to be on the increase. Senile degenerative processes are of great significance in the causation of macular holes without a relevant history of trauma. The holes themselves represent a terminal stage of various pathologic processes. Trauma may either cause a mechanical tearing of the retina or lead to cystoid degeneration, which, according to Tower, is the most frequent precursor of hole in the macula. The older view that cystoid degeneration is the exclusive precursor of macular holes is rejected by the author. The ophthalmoscopic appearance of various types of holes is described. The author calls attention to the fact that the punched-out margin of macular holes should no longer be considered typical of all holes. In those cases in which perifoveal
Observations on Hole in the Macula.. AMA Arch Ophthalmol. 1954;52(4):654. doi:10.1001/archopht.1954.00920050656017