Fundus — Macular Hole Stage 4

A 68-year-old woman presents with gradual onset central vision loss and metamorphopsia for 3 months. Fundus examination reveals a round foveal defect with a yellow ring at the edges and an operculum visible above the hole. OCT confirms a full-thickness neurosensory retinal defect measuring 450 μm at the fovea, with complete posterior vitreous detachment. The structure marked **A** in the diagram represents this full-thickness defect. Which of the following best describes the pathogenic mechanism and the most appropriate management for this stage 4 macular hole?