Full-thickness macular holes (FTMH) usually result in a pronounced reduction of visual acuity and represent one of the most frequent indications for retinal surgery. If diagnosed and treatment is initiated at an early stage, surgery has a high success rate with respect to both hole closure and improvement of visual acuity. Optical coherence tomography (OCT)-based staging and sizing enables an estimation of the surgical outcome. The differential diagnostic distinction from clinically similar disorders, such as lamellar macular holes, macular pseudoholes, and foveoschisis is clinically relevant as the pathogenesis, prognosis and treatment are significantly different. While vitrectomy with peeling of the inner limiting membrane (ILM) and gas tamponade is established as the standard treatment for FTMH, some aspects of treatment are handled differently between surgeons, such as the timing of surgery, the choice of endotamponade and the type and duration of postoperative positioning. For FTMH associated with vitreomacular traction, alternative treatment options in addition to vitrectomy include intravitreal ocriplasmin injection and pneumatic vitreolysis. The current clinical guidelines of the German ophthalmological societies summarize the evidence-based recommendations for diagnosis and treatment of FTMH.
UNASSIGNED: Das Makulaforamen führt in der Regel zu einer ausgeprägten Visusminderung und stellt eine der häufigsten Indikationen für eine netzhautchirurgische Behandlung dar. Bei frühzeitiger Diagnosestellung und Therapieeinleitung hat die Netzhautchirurgie eine sehr hohe Erfolgsrate sowohl in Bezug auf den Foramenverschluss als auch die Visusbesserung. Die Stadien- und Größeneinteilung mittels optischer Kohärenztomographie (OCT) ermöglicht eine Abschätzung des chirurgischen Ergebnisses. Die differenzialdiagnostische Abgrenzung gegenüber klinisch ähnlichen Krankheitsbildern wie Makulaschichtforamen, Pseudoforamen und Foveoschisis ist relevant, da sich Pathogenese, Prognose und Therapie deutlich unterscheiden. Während die Vitrektomie mit Peeling der inneren Grenzmembran (ILM) und Gastamponade als Standardtherapieverfahren des Makulaforamens etabliert ist, werden einzelne Aspekte der Behandlung wie der Zeitpunkt der Operation, die Wahl der Endotamponade und die Art und Dauer der postoperativen Lagerung unterschiedlich gehandhabt. Bei Assoziation mit einer vitreomakulären Traktion werden neben der Vitrektomie auch alternative Behandlungsoptionen wie die intravitreale Ocriplasmin-Injektion und die pneumatische Vitreolyse diskutiert. In einer aktuellen S1-Leitlinie der deutschen ophthalmologischen Fachgesellschaften werden evidenzbasierte Empfehlungen zur Diagnostik und Therapie des Makulaforamens zusammengefasst.

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A consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.
The panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.
The panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle\'s fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.
The use of the proposed definitions may provide uniform language for clinicians and future research.

OBJECTIVE: To evaluate the agreement and predictability of ocriplasmin treatment effects among retinal experts (raters) by assessment of retinal imaging data of eyes treated for vitreomacular traction in nine different centers in Germany and Austria.
METHODS: Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success.
RESULTS: Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16.
CONCLUSIONS: These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.

In view of diverging opinions for retinal detachment surgery (pneumatic retinopexy or buckling procedure with or without drainage versus primary vitrectomy without external buckling) pneumatic retinopexy, orbital balloon, buckling procedures (sponge, encircling band) are discussed with a short historical background and a brief description of current technology. Pros and cons of the individual technique are discussed on the basis of monographs and articles. From the repertoire of a retinal surgeon typical case examples are presented, different operation methods discussed, advantages and disadvantages of each individual technique emphasized. A goal of the work is to provide a practicable manual for the less experienced surgeon and the expert, who experiences an increasing trend to vitrectomy techniques instead of the conventional buckling procedures.

BACKGROUND: Concerning the indications, progression in course and the possible complications, the different methods of treatment in cases of retinoschisis in its different expressions were examined. A staging of senile retinoschisis is presented.
METHODS: Patients\' natural course, prophylactic treatment against expansion and treatment of retinal detachment were examined.
RESULTS: The lateral and central barrier of laser or cryo around the schisis is contradictory since a progression in direction to the macula is the result. Three of such cases could be found. In 6 of 52 cases with prophylactic treatment of an outer layer defect with cryo the result was a schisis detachment. In all these cases a retinal reattachment was performed with the Custodis procedure. The final anatomic result of 95 treated schisis retinal detachments was a 98% success. The symptomatic or progressive cases had a little less favourable outcome.
CONCLUSIONS: The only indication for treatment of a schisis at present is the symptomatic or progressive schisis detachment with threatening of the macula. Lateral or central barring of a schisis or treatment of the borders of an outer layer retinal break should be avoided. The rate of reattachment and the functional results are better than in the group of rhegmatogenous retinal detachments including the 50.5% schisis retinal detachments without symptoms.