Uveitis et al. reported MH formation in 2.6%

Uveitis can give rise to a wide range of macular
pathologies including macular edema, MH, ERM and CNV formation. In a large
cohort of 413 eyes with uveitis, Liu et al. reported MH formation in 2.6% eyes.(110)
Panuveitis like Vogt-Koyanagi-Harada (VKH) syndrome and Behcets disease
(BD) are the most common associations.(111–120) MH less commonly occurs in anterior
uveitis, idiopathic pars planitis, idiopathic posterior uveitis, CMV retinitis,
and serpigenous choroidopathy (SC).(110,121–125)

BD is a chronic multisystem disorder characterized by
relapsing inflammation of unknown etiology, with ocular involvement in the form
of posterior uveitis or panuveitis, in about 70% of all cases.(114) Males are affected more than females
(73.8% – 88%). The prevalence of MH has been reported between 2.5 – 6.6% in BD.(113,117) VKH disease is a multi-systemic
inflammatory disorder of melanin containing tissues and presents often with
panuveitis. Three case reports of MH exist with VKH, two in the convalescent
stage and one in the acute uveitic stage.

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The various mechanisms suggested for origin of MH in
eyes with uveitis include inflammation induced PVD induction and VMT
(antero-posterior traction), horizontal traction by ERM, cystoid degeneration
of fovea, and vitreous gel shrinkage secondary to vitritis.(113,117,118) The characteristic features of these
MH are surrounding pigmentary changes, presence of ERM, cystoid edematous
edges, and underlying outer retinal disruption and RPE atrophy.

Vitrectomy with ILM peeling is usually an effective treatment
for anatomical MH closure. Sometimes, the control of inflammation and
resolution of macular edema with steroids and ERM formation and contraction can
lead to spontaneous closure of the MH.(111,122,125) Prognosis of surgery depends on the
perfusion status of the macula and RPE disturbances as sequelae of long
standing inflammation. Long standing cases have limited visual recovery due to
associated underlying RPE atrophy and photoreceptor loss. 

 

1.           
Degenerative

a.           
Age related macular degeneration

Macular
hole secondary to AMD is a rare entity.(126–128) Wan et al. reported a macular hole
developing after a subretinal haemorrhage in a patient with wet AMD.(126) It was proposed that the subretinal
haemorrhage led to an increased tangential pressure in the subretinal space
with foveal dehiscence. In addition, the resultant RPE stimulation and
increased fibrotic reaction may also have contributed. Tomohiro et al. (127) and Meyer et al.(128) independently described cases of
neovascular AMD which had an associated macular hole. The probable cause put by
these authors was a tractional force generated at the vitreo-retinal interface due
to an inflammatory reaction related to AMD and/or intravitreal injection. A
good surgical outcome was obtained with vitrectomy combined with gas tamponade
and ILM peeling in these cases. However vision improvement was limited due to defects
in the ellipsoid zone and irregularities in the photoreceptor layer and RPE
evident on OCT in the post operative period.

b.           
Nonspecific Pigment epithelial
detachment related

Cazabon et al. described two cases of MH development
associated with PED.(129) Subfoveal PED causes elevation of
the fovea with stretching of the photoreceptor layer by physical forces thus
affecting the structural support of the fovea. This makes it more susceptible
to vitreofoveal tractional forces, which can initiate a neurosensory retinal
detachment and ultimately a FTMH. Good recovery of visual acuity was noted in
the post operative period with standard surgical approach.