Management options for early stages of acutely symptomatic macular holes

Abstract

PURPOSE: To evaluate management options for acutely symptomatic stage I macular holes, and vitrectomy with intraocular gas tamponade for advanced stage I macular holes.METHODS: Retrospective noncomparative study. Setting: Clinical practice. Study population: Acutely symptomatic stage I macular holes. Management options: (I) spontaneous resolution with observation −7 eyes; (II) stage I holes developing poor visual acuity of 20/50 or worse during observation −9 eyes undergoing pars plana vitrectomy, posterior vitreous separation, fluid −20% sulfur hexafluoride gas exchange; (III) stage I holes acutely progressing to stage II or III during observation −9 eyes with vitrectomy, posterior vitreous separation, membrane peel, fluid −18% perfluoropropane gas exchange. Main Outcome Measures: visual acuity of 20/40 of better, prevention, or closure of macular hole.RESULTS: Spontaneous resolution developed in 7 eyes with 20/40 or better vision (group I). 8/9 eyes undergoing vitrectomy for advanced stage I holes (group II) did not progress and recovered 20/40 or better vision. 1/9 recovered 20/40 vision after further surgery. 9/9 eyes following acute progression to full-thickness holes (group III) had closed macular holes with recovery of 20/40 vision after vitrectomy.CONCLUSIONS: Stage I macular holes can initially be observed. However, excellent visual and surgical results can be obtained in stage I holes with poor vision, or with acute progression to full-thickness holes.