Role of a distinctive choroido-retinal lesion in the pathogenesis of retinal hole; a clinical and pathological report.

THE association of retinal holes with retinal detachment was described shortly after the use of the ophthalmoscope began (Coccius, 1853). Since the work of Gonin (1931) it has been generally accepted that the retinal hole is the immediate and causative precursor of the detachment. Hole formation is not the primary lesion but results from degeneration, usually cystoid in type, or from atrophy of the retina (Zeeman, 1912; Leber, 1916; Gonin, 1934; Vogt, 1936a, b). Possibly a disturbance of the vitreous also precedes hole formation, local fibrillar attachments of the vitreous being capable of disrupting the remaining fine inner layer of the retina (Leber, 1882; Nordenson, 1887; Deutschmann, 1895, 1899; Addario, 1904; Gonin, 1904; Lister, 1924; Rotth, 1933). The retinal degeneration or atrophy and the local vitreous changes are in turn probably not primary changes. The retinal condition depends upon the nutritional supply which has a double source-the chorio-capillaries and the retinal capillaries. Various factors may affect the nutritional supply. Myopia or perhaps senility may affect the chorio-capillaries (Hanssen, 1919) and unknown factors may cause a disturbance of the fine retinal vessels and so cause retinal degeneration (Iwanoff, 1864; Greeff, 1900; Best, 1904; Zeeman, 1912; Leber, 1916; Rahnenfiihrer, 1916; Bruno, 1936; Vogt, 1936a, b). A choroido-retinitis may lead to obstruction of the capillaries of both choroid and retina (Elschnig, 1914; Gonin, 1923; Vogt, 1929; Arruga, 1931; Duke-Elder, 1940). In the latter connexion a distinctive choroido-retinopathy has been described as frequently present in the neighbourhood of retinal holes (Michaelson, 1955). It is characterized by local pigment disturbance of the choroid and by phlebo-sclerosis in the overlying retina, the choroidopathy preceding the visible retinal changes. The present report is concerned with a clinical description of further cases in which distinctive choroido-retinopathy was present in the region of a retinal hole. In one case it was possible to examine the eye histologically.