1.What is macular fissure?
Macular fissure refers to the loss of the entire neuroepithelium in the center of the macula (as shown below), which severely damages the patient’s central vision. The disease starts insidiously, patients show varying degrees of vision loss, visual distortion, and the central gaze point is a dark spot. The prevalence of the disease accounts for about 3.3 per 1000 of the population, among which idiopathic macular fissure of unknown origin is the most common (about 83%), often occurring in elderly women.
2.How does macular fissure occur?
Trauma, high myopia, cystoid macular edema, inflammation, retinal degeneration-like diseases, macular pre-membrane and eclipse retinopathy may lead to secondary macular fissure, while the pulling of the tangential direction of the retinal surface in the macular area is the main reason for the formation of idiopathic macular fissure. In the process of human aging, due to the liquefaction of vitreous and the occurrence of posterior vitreous detachment, so that the retinal surface often residual part of the posterior vitreous cortex, due to the value-added of vitreous cells in these residual posterior cortex, the retinal surface in the central macular sulcus area formed parallel to the retinal surface of the retinal traction, the initial occurrence of the central macular sulcus detachment, followed by the central sulcus detachment, and finally the formation of macular whole-layer fissure.
3.Stage of macular fissure
According to the pathogenesis, Gass divided the idiopathic macular lacunae into 4 stages.
Stage I: It is the first stage of macular fissure formation, only the central sulcus is detached, vision is mildly reduced, yellow spots or yellow rings can be seen in the central sulcus, about half of the cases will be spontaneous remission;
Stage II~IV is a full-layer fissure.
Stage II: 400μm fissure, eccentric half-moon, horseshoe-shaped or oval;
Stage III: 400μm round hole, the posterior vitreous cortex is still adherent to the macula in II-III;
Stage IV: posterior vitreous detachment has occurred.
Normal Stage I
Stage II Stage III
Stage IV
4.What should I do if I have macular fissure?
In recent years, due to the in-depth research on the pathogenesis of macular fissure, the method of vitrectomy to remove the vitreous cortex in front of the central recess has been carried out to promote the closure of the macular fissure and the reset of the superficial retinal detachment around the fissure.
Indications for surgery.
A. Clearly diagnosed as stage II~IV idiopathic macular fissure, with obvious loss of visual acuity (0.05~0.4) and obvious visual distortion.
B. Those who have macular fissure formation within one year and are willing to undergo surgery.
In the staging of macular fissure by Gass, stage I macular fissure does not form full macular hole, and about 1/2 patients with stage I macular fissure can spontaneously resolve, so surgery for stage I macular fissure is mostly not advocated, and surgery can be carefully chosen for patients with high risk of developing full macular hole.