Understanding the classification and new treatment trend of idiopathic macular hole to improve its diagnosis and treatment outcome

Abstract

Appropriate classification and staging is the basis for the diagnosis and treatment of idiopathic macular hole (IMH). According to the appearance of vitreous and retina determined by optical coherence tomography, IMH can be classified as primary or secondary IMH, and IMH with or without vitreous attachment; Vitreous attachment can be further classified as vitreomacular adhesion or vitreomacular traction. According to the measured horizontal diameter, IMH can be classified as large, middle and small IMH. This new classification system and comprehensive parameters improve the traditional Ⅳ-stage theory, with a better description of the occurrence and development of IMH process. It should be used as the general principal to guide IMH classification, evaluation of surgical indications, selection of operative method, and estimation of surgical outcome. Ganglion cell damage caused by internal limiting membranes (ILM) peeling is the major concern in the IMH vitreoretinal surgery. For complicated and large IMH, inverted ILM flapping can improve the closure rate; ILM peeling and postoperative face-down posture are not necessary for IMH less than 250um in diameter. The current vitreoretinal surgery trend to treat IMH is personalized surgical treatment, following the existing evidence-based medical evidence, and based on the new classification information, ocular and systemic features of each patient. Key words: Macular hole/ diagnosis; Macular hole/ therapy; Editorial