15 - Surgery for recurrent, persistent, or large macular holes

Abstract

The treatment of recurrent macular holes is still a challenge for a retinal surgeon. The failure rate of primary surgery in idiopathic macular hole is less than 10%. In recent years, many management options have been proposed, such as laser treatment, a second operation with transforming growth factor-beta 2 application, autologous platelet concentrate, or different tamponades such as silicone oil to achieve its closure. Modern approaches to recurrent macular holes are the use of a plug of internal limiting membrane (ILM) peeled from the periphery of the posterior pole and inserted into the macular hole, a neurosensory retinal free flap, or capsular lens fragments. Recently, new techniques, involving retinal mobilization or a human amniotic membrane plug or autologous retina transplanted into the subretinal space to treat failed macular holes, are presented. These techniques may improve anatomical and functional results. Also, laser and gas-fluid exchange in the office offers a method of repairing recurrent or failed macular holes without returning to the operating room. Many of these techniques are discussed in great detail in this chapter.