I enjoyed the article by Smiddy1 in the May 1993 issue of the Archives. The occurrence of macular holes in eyes that have presumably no cortical vitreous, either because of a previous posterior vitreous detachment and rhegmatogenous retinal detachment or because of vitrectomy surgery, is indeed difficult to reconcile with present theories of macular hole formation.
There are at least three articles concerning the vitreoretinal juncture by Foos,2-4 which I think might offer an additional explanation for this enigma. Although this work was done in the mid-1970s, it reflects painstaking electron microscopic studies of the vitreoretinal interface in normal autopsy eyes of all ages.
Briefly, Foos2-4 found that accessory glia in the superficial retina commonly migrate through breaks in the retinal surface and form either simple or complex epiretinal membranes in the posterior pole. Vitreous was usually not incorporated in these membranes. In his study of 63
Watzke RC. Atypical Presentations of Macular Holes. Arch Ophthalmol. 1994;112(4):446. doi:10.1001/archopht.1994.01090160020002
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