Hole Closure Research Articles

PREDICTIVE FACTORS OF SURGICAL SUCCESS WITH THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE.

To present new morphologic features correlating with functional and anatomical outcomes of the inverted internal limiting membrane flap technique in full-thickness macular hole. A retrospective study of 51 successful and 22 failed full-thickness macular hole surgeries. In all eyes, preoperative spectral domain optical coherence tomography (SD-OCT) or swept source optical coherence tomography (SS-OCT) were reviewed. The presence of supraretinal pigment epithelium granular deposits, presence of an epiretinal membrane or epiretinal proliferation, visibility of posterior hyaloid, continuity of the interdigitation zone or external limiting membrane, presence of cystoid spaces, irregular surface of the margins of full-thickness macular hole, visibility of the suprachoroidal space, and diameters of full-thickness macular hole were analyzed. In multivariate analysis, the success of the first surgery depended solely on the absence of epiretinal membrane ( P < 0.05).In univariate analysis, the success of the first surgery was correlated moreover with the absence of preoperative supraretinal pigment epithelium granular deposits ( P = 0.0010), the absence of an epiretinal proliferation ( P = 0.0060), and the absence of an irregular border of the hole ( P = 0.010). In multivariate analysis, epiretinal membranes were a negative prognostic factor for macular hole closure when the inverted internal limiting membrane flap technique was used. Worse final visual acuity was observed in patients with primary anatomical failure, even if the hole was successfully closed during the second intervention.

Treatment of persistent flap closure with fluid gas exchange after inverted internal limiting membrane flap technique for idiopathic macular hole.

We evaluated the results of fluid-gas exchange (FGE) for long-term flap closure of idiopathic macular holes (MH) using the inverted internal limiting (ILM) flap technique. We retrospectively included eyes showing flap closure without complete MH closure and connection of separate macular tissue 1 month postoperatively after the inverted ILM flap technique was detected by ocular coherence tomography at follow-up. Eyes remained flap closure at 2 months after surgery further underwent in-office FGE with 16% C3F8. Of the 153 eyes using the inverted ILM flap technique for idiopathic MH between June 2015 and November 2018, 10 eyes (6.99%) remained flap closure at 1 month postoperatively. Among 10 eyes, 5 eyes (50%) showed flap closure at 2 months postoperatively further underwent FGE for complete MH closure, while the remaining 5 eyes (50%) progressed directly to normal macular structures at 2 months postoperatively. Improvement in vision of all flap closure from baseline was significant (P = .015), with a mean baseline vision of 1.19 [Snellen equivalent (SE), 20/307] ± 0.52 logMAR and the mean final vision of 0.63 (SE, 20/85) ± 0.38 logMAR. The group that underwent FGE showed better final vision of 0.45 (SE, 20/75) ± 0.23 logMAR than the group that did not undergo FGE (0.81 [SE, 20/128] ± 0.44 logMAR). All eyes achieved complete MH closure, including the eyes that underwent FGE in a mean period of 5.60 months (range 3-10 months) after the inverted ILM flap technique. Eyes that underwent FGE achieved a higher rate of foveal restoration [complete external limiting membrane 80%; complete ellipsoid zone (EZ) 60%] than those that did not receive FGE (complete external limiting membrane: 40%; complete EZ: 10%). Eyes with persistent flap closure for more than 2 months postoperatively that underwent FGE showed accelerated complete MH closure, better final vision, and foveal restoration.

Nuclear envelope assembly relies on CHMP-7 in the absence of BAF-LEM-mediated hole closure.

Barrier-to-autointegration factor (BAF) protein is a DNA-binding protein that crosslinks chromatin to allow mitotic nuclear envelope (NE) assembly. The LAP2-emerin-MAN1 (LEM)-domain protein LEMD2 and ESCRT-II/III hybrid protein CHMP7 close NE holes surrounding spindle microtubules (MTs). BAF binds LEM-domain family proteins to repair NE ruptures in interphase, but whether BAF-LEM binding participates in NE hole closure around spindle MTs is not known. Here, we took advantage of the stereotypical event of NE formation in fertilized Caenorhabditis elegans oocytes to show that BAF-LEM binding and LEM-2-CHMP-7 have distinct roles in NE closure around spindle MTs. LEM-2 and EMR-1 (homologs of LEMD2 and emerin) function redundantly with BAF-1 (the C. elegans BAF protein) in NE closure. Compromising BAF-LEM binding revealed an additional role for EMR-1 in the maintenance of the NE permeability barrier. In the absence of BAF-LEM binding, LEM-2-CHMP-7 was required for NE assembly and embryo survival. The winged helix domain of LEM-2 recruits CHMP-7 to the NE in C. elegans and a LEM-2-independent nucleoplasmic pool of CHMP-7 also contributes to NE stability. Thus, NE hole closure surrounding spindle MTs requires redundant mechanisms that safeguard against failure in NE assembly to support embryogenesis.

Anatomical and functional outcomes of idiopathic macular hole surgery with fovea-sparing versus conventional internal limiting membrane peeling

Purpose: To compare fovea-sparing and conventional internal limiting membrane (ILM) peeling in idiopathic macular hole (IMH) surgery in terms of IMH closure type, hole closure incidence and visual outcome. Material and Methods: The ILM was peeled around the IMH in the conventional ILM peeling group. In the fovea-sparing ILM peeling group, an ILM flap was created temporally to the IMH (with an ILM remnant left attached to the margins of the IMH), folded over the hole and stabilized with viscoelastic. Gas tamponade with 20% SF6 or 15% С3F8 was used. In the postoperative period, IMH closure pattern was assessed. Thicknesses of the outer retinal layers, inner retinal layers and retinal nerve fiber layer in the macular region were measured at 1 and 3 months. Results: Totally, 70 patients (15 males and 55 females) had an IMH surgery in 71 eyes. The mean age (SD) was 65.7 (6.8) years. The median IMH duration (interquartile range (IQR)) was 3.0 (1.0-6.0) months, and the mean preoperative BCVA (standard deviation (SD)), 0.19 (0.16). Thirty-four eyes had an IMH surgery with conventional ILM peeling, and 37 eyes, an IMH surgery with fovea-sparing ILM peeling. The two groups were matched in terms of preoperative visual acuity and macular hole duration. IMH closure was achieved in 30/34 eyes (88.2%) in the conventional ILM peeling group and 33/37 eyes (89.2%) in the fovea-sparing ILM peeling group. Particularly, IMH closure was achieved in 13/17 eyes that received gas tamponade with 20% SF6 and 20/20 eyes that received that with 15% С3F8 in the latter group. The rate of correct IMH closure pattern was substantially higher (64% versus 47%) and median postoperative BCVA (IQR), significantly better (0.55 (0.35-0.7) versus 0.43 (0.35-0.6), р = 0.039) in the fovea-sparing ILM peeling group than in the conventional ILM peeling group. An analysis of variance found a significant effect of the type of IMH surgery and IMH closure pattern on the postoperative BCVA (F1 = 5.06, p = 0.027; F2 = 7.9, p = 0.0001). In both groups, we found a significant thinning of the total retinal thickness in the central 1-mm foveal zone at 3 months compared to 1 month after surgery. There was a significant thinning of the outer and inner retinal layers in the conventional ILM peeling group, and no significant thickness changes in the retinal layers in the fovea-sparing group. Conclusion: Our fovea-sparing ILM peeling technique is an effective treatment option for IMHs, and when used with gas tamponade with 15% С3F8, enabled a primary surgery IMH closure rate of 100%.

First person – Sarah Barger

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Journal of Cell Science, helping researchers promote themselves alongside their papers. Sarah Barger is first author on ‘ Nuclear envelope assembly relies on CHMP-7 in the absence of BAF–LEM-mediated hole closure’, published in JCS. Sarah is a Postdoctoral Fellow in the lab of Shirin Bahmanyar at Yale University, USA, investigating the role of nuclear envelope proteins in cancer initiation and progression.

Characteristics and surgery outcomes of macular hole diagnosed after rhegmatogenous retinal detachment repair.

To report the characteristics and the visual and anatomical outcomes of secondary macular holes (SMHs) diagnosed after rhegmatogenous retinal detachment (RRD) repair and their associated factors. Retrospective, interventional case series. All consecutive patients who were diagnosed with SMH after RRD repair at Beijing Tongren eye center from January 2016 to April 2021 were included. Patients who had their primary RRD repair in other hospitals and were referred to our center after diagnosis of SMH were also included. The minimum follow-up time after RRD repair was 6months. 37 SMHs were diagnosed within a series of 5696 RRDs. Including 24 eyes referred from other hospitals after the diagnosis of SMH, 61 eyes were included. The type of primary RRD repair surgery included 22/61 (36%) eyes with scleral buckling procedure (SBP) and 39/61 (64%) eyes with pars plana vitrectomy (PPV). 21/61 (34%) eyes had recurrent RD. The median time to SMH diagnosis was 150days (range, 7 ~ 4380days). Macular hole (MH) closure was achieved in 77% eyes. Visual acuity (VA) improvement of at least 2 lines of Snellen's visual acuity was observed in 51% eyes. Final MH closure status was associated with preoperative MH diameter (for every 50μm increment) (P = 0.046, OR = 0.875, 95%CI: 0.767 ~ 0.998). VA improvement was associated with final MH closure status (P = 0.009, OR = 8.742, 95%CI: 1.711 ~ 44.672). Final VA (logMAR) was associated with recurrent RD (P < 0.001, B = 0.663, 95%CI: 0.390 ~ 0.935), preoperative MH diameter (P = 0.001, B = 0.038, 95%CI: 0.017 ~ 0.058), VA at the time of SMH diagnosis (P < 0.001, B = 0.783, 95%CI: 0.557 ~ 1.009) and final MH closure status (P = 0.024, B = -0.345, 95%CI: -0.644 ~ -0.046). For patients without recurrent RD, VA improvement and final VA was associated with final MH closure status (P = 0.016 and P < 0.001, respectively), while for patients with recurrent RD, VA improvement or final VA did not associate with final MH closure status (P > 0.05). For SMH diagnosed after RRD repair, final MH closure status was associated with preoperative MH diameter. Recurrent RD, larger preoperative MH diameter, worse VA at the time of SMH diagnosis and failed MH closure are predictive factors for worse final VA. Visual outcome is associated with final MH closure status in patients without recurrent RD, but not as so in patients with recurrent RD.

Closure of a Chronic Traumatic Macular Hole Following Phacoemulsification Surgery.

To report a case of chronic traumatic macular hole closure following an uncomplicated phacoemulsification surgery. Retrospective chart review with optical coherence tomography imaging. 42-year-old woman with a 20-year history of a traumatic macular hole and cataract in the right eye underwent an uncomplicated phacoemulsification surgery. Following surgery, the patient was prescribed prednisolone acetate 1% four times per day, which was tapered off by postoperative month 1. By postoperative month 1, the full-thickness macular hole had closed. This unique case illustrates the closure of a full-thickness macular hole following cataract surgery. We hypothesize that closure of the macular hole was aided by the use of topical steroids in the postoperative period, allowing for resolution of the cystic intraretinal fluid and hole closure.

Novel surgical technique for macular holes with basal diameter &gt;1000 μ

Abstract: Closure rate of full-thickness macular holes (FTMHs) with basal diameter &gt;1000 μ is known to be poor. Patients presenting with FTMH having a minimum basal diameter of &gt;1000 μ without any coexistent retinal morbidity were offered vitrectomy, internal limiting membrane peeling, retinal massage, and aspiration of subretinal fluid from the MH. Visual acuity (VA) and spectral-domain optical coherence tomography (SD OCT) assessments were performed at baseline, week 1 after surgery and at postoperative months 1, 3, 6, and 12. VA, type of hole closure, presence of ellipsoid zone, and external limiting membrane defect were monitored. The primary endpoint was type 1 anatomical hole closure. Secondary outcome measure was a change in VA from baseline to 6-month follow-up and persistent hole closure at the final follow-up of 12 months. The mean age was 67.1 ± 9.1 years. Seven eyes were pseudophakic, and two underwent combined phacoemulsification with MH surgery. The mean minimum basal diameter of FTMH was 1162.4 ± 161 μ. The mean duration of visual loss was 11.3 ± 1.93 months. Type 1 closure of FTMH was seen in all patients on SD OCT, on the 7th postoperative day. The mean presenting VA was 1.06 ± 0.1 Logarithm of the minimum angle of resolution (logMAR). Best-corrected visual acuity improved to 0.91 ± 0.09 logMAR at 1-month follow-up (P = 0.005) (95% confidence interval [CI]: 0.061–0.251), 0.63 ± 0.1 logMAR (P &lt; 0.001) (95% CI 0.339–0.527) at 3 months, and 0.55 ± 0.05 logMAR (P &lt; 0.001) (95% CI 0.414–0.609) at 6 months. All holes were found closed at the final follow-up of 12 months. This novel technique can help achieve better outcomes and raise the primary anatomical success rate of FTMH with basal diameter &gt;1000 μ.

ILM Insertion for the Treatment of Macular Hole Associated with Phakic Intraocular Lens Implantation

Purpose: To report a case of macular hole closure using an internal limiting membrane (ILM) flap following implantation of a posterior chamber phakic implantable contact lens (ICL).Case summary: An 18-year-old female patient presented with visual loss of the left eye after ICL implantation. She had high myopia of -12.5 diopter (spherical equivalent) and a corrected visual acuity of 2/100. The fundus photograph and optical coherence tomography showed a full-thickness macular hole measuring 688 µm in width and 976 µm in length. The ILM around the hole was detached from the retinal surface, which was greater in size than the macular hole. The initial surgical intervention involved vitrectomy, inverted ILM flap placement, and gas tamponade. The decrease in gas volume was associated with a loss of the ILM flap. For hole closure, the remaining ILM flap in the peripheral macula was harvested and inserted in the hole during the second surgery. The silicone oil was used for tamponade. One month after ILM insertion, complete closure of the hole was observed. The visual acuity improved to 20/40 after silicone oil removal.Conclusions: A large full-thickness macular hole developed after ICL implantation in a patient with high myopia. Macular hole surgery using ILM insertion and prolonged tamponade closed the hole and effectively improved the visual acuity.

Minimal Posterior Pole Vitrectomy and Fixing the Inverted Internal Limiting Membrane Flap with DisCoVisc for Macular Hole: No Gas or Air Tamponade.

To investigate an alternative surgical method for macular hole repair without fluid-air exchange, gas tamponade, and prone positioning. Eighteen eyes of 17 patients with macular holes underwent minimal posterior pole vitrectomy with an inverted internal limiting membrane flap technique. Ophthalmic viscosurgical device was used to fix the inverted internal limiting membrane flap in the balanced salt solution. No fluid-air exchange, gas tamponade, or prone positioning was needed. Follow-ups were performed at 1 day, 1 week, and the last visit (ranging from 3 to 6 months) after surgery. Optical coherence tomography examination, intraocular pressure, and best-corrected visual acuity measurements were performed preoperatively and at every follow-up, postoperatively. Primary closure of the macular hole was observed in all 18 eyes (100%). Optical coherence tomography showed U-type closure in 12 eyes, V-type closure in five eyes, and W-type closure in one eye. Preoperative, postoperative 1 week, and last follow-up best-corrected visual acuity were 0.90 (Snellen equivalent 20/159) ± 0.31 LogMAR, 0.72 (Snellen equivalent 20/105) ± 0.33 LogMAR, and 0.48 (Snellen equivalent 20/60) ± 0.32 LogMAR, respectively. Postoperative visual acuity was significantly improved compared with preoperative values ( F = 19.250, P = 0.000). No significant difference in intraocular pressure was found compared with preoperative values ( F = 1.933, P = 0.168). No significant complications were observed. This surgical method can effectively close macular holes, improve visual acuity, enhance surgical efficiency, reduce surgical complications, and improve patients' postoperative experience without the need for fluid-air exchange, gas tamponade, or prone positioning.

Vitreoretinal Abnormalities during Macular Hole Repair in Alport Syndrome.

To describe abnormal vitreoretinal findings during macular hole repair in Alport syndrome (AS). Case report of preoperative, intraoperative, and postoperative findings related to macular hole surgery in a patient with AS. A 50-year-old woman with Alport syndrome was found to have bilateral full-thickness macular holes. Surgery was recommended for her left eye given recent onset of vision loss and smaller hole size (313 um). Intraoperatively, the vitreous was found to have fine fibrillar strands and to be abnormally adherent to the retinal surface. There was little to no internal limiting membrane (ILM) present. Vitrectomy was performed with posterior cortical hyaloid peeling and 15% C3F8 gas tamponade. Two months after surgery, the macular hole was successfully closed. Abnormal vitreous composition and adherence to the retinal surface may contribute to macular hole formation in AS patients. Standard surgical approaches including ILM peeling may not be feasible, though thorough removal of the posterior cortical hyaloid may be sufficient to achieve macular hole closure.

Stability of an axisymmetric two-grain system with a hole

The stability of holes in solid thin films is crucial, as an absence of holes is necessary in some applications and holes are needed in others. We develop an axisymmetric two grain model with a central hole, with surface diffusion governing the exterior surfaces and mean curvature motion governing the grain boundary. The model can exhibit grooving, wetting, dewetting, as well as void, hole, and hillock formation. Here, we extend an earlier work [Zigelman and Novick-Cohen, J. Appl. Phys. 130, 175301 (2021)], where it was shown for an axisymmetric single grain system with a hole at the center that there exists a critical effective radius, which is independent of the contact angle. The stability of the steady states, which consist of coupled nodoidal and catenoidal surfaces, is analyzed numerically by imposing the steady state configurations as initial conditions. This approach yields stability criteria in terms of (i) the effective energy, (ii) the ratio between the maximal thickness of the inner and outer grains, (iii) a generalized effective radius, and (iv) the ratio between the mean curvature of the exterior surfaces and the total volume of the system. Some of these criteria partially reflect the Rayleigh stability criterion. Hillock formation tends to be stabilizing. Modes of instability include growth of one grain at the expense of the other, breakup induced by grooving, and hole closure.

Modified ILM flap technique for macular hole.

Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain anatomical closure. However, there are still challenges when the hole is large and chronic (>400 microns) in nature. Here we describe a modified technique of internal limiting membrane (ILM) peeling which results in the successful closure of such macular holes. To demonstrate modified ILM flap techniques in management of chronic macular holes. Here we have described the role of modified ILM peeling techniques in three different cases such as chronic traumatic macular hole >400 microns, chronic idiopathic macular hole >400 microns and <400 microns. This modified ILM flap technique provides the benefit of an inverted ILM flap, which helps in glial proliferation and also relives tangential traction thereby aiding in successful macular hole closure in chronic cases. https://youtu.be/RKVLd1mSw08.

Autologous neurosensory retinal transplantation.

Macular hole is a full-thickness neuroretinal defect in the fovea. The surgical solution is the removal of the internal limiting membrane (ILM) during vitrectomy with gas filling. Several surgical techniques have been described for the closure of refractory macular holes (about 5%), that reappear after successful surgery or do not close despite surgery. This article presents the first autologous neurosensory retina transplantation performed in Hungary for a large, refractory, full-thickness macular hole, with a brief overview of macular hole surgery. In September 2022, we performed a combined phacovitrectomy with ERM/ILM peeling and SF6 gas filling due to cataract, epiretinal membrane (ERM), and large macular hole due to the deterioration of vision in our patient's left eye for months, with a visual acuity of 6%. We drew the patient's attention to the importance of postoperative head positioning, which she ignored. With a visual acuity of 4%, due to a refractive macular hole (at the base: 983 μm, at the smallest diameter: 609 μm), on December 14, 2022, autologous neurosensory retina transplantation was performed using intraoperative OCT (Zeiss ARTEVO 800). At the end of the surgery, decalin was left in the eye to keep the graft in place, and the patient spent 5 days in a supine position. The decalin was removed with another operation, followed by C3F8 gas filling. 8 weeks after surgery, we documented a closed macular hole with 20% visual acuity, which was stable during the 6-month follow-up. Among the options considered for the resolution of refractory macular holes, autologous neurosensory retinal transplantation, which results in a visual improvement of our patient, is an intervention worth considering. Intraoperative OCT was a great help in performing the surgery. Although the decalin left temporarily in the eye helps to keep the transplant in place, it requires a continuous supine position and another operation is essential to remove it. Further experience is needed to establish the exact indication for autologous neurosensory retinal transplantation. Orv Hetil. 2023; 164(38): 1511-1517.

Macular hole repair: the effect of size and nonsupine posture on postoperative outcomes.

Postoperative face-down positioning (FDP) for up to 2 weeks is believed to be necessary for successful closure of macular holes. FDP, however, can be disabling and uncomfortable and is a major burden for elderly patients. The aim of this study was to investigate how nonsupine posturing and macular hole size affect anatomical and functional success of macular hole closure. The medical records of patients with idiopathic macular holes who were treated surgically between 2016 and 2019 were reviewed retrospectively. Exclusion criteria included vitreomacular traction, previous retinal detachment, or chronic macular hole. A total of 115 eyes of 115 patients were included. Average age was 69.2 ± 8.2 years; 63 patients (55%) were female. Anatomical success was achieved in 108 patients (94%) with a single operation. In small holes (<400 μm), closure was seen in 98% of cases (95% CI, 94%-100%); in large holes (≥400 μm), 90% of cases (95% CI, 76%-94%). Visual acuity remained stable or improved in 108 patients (92%). Average preoperative best-corrected visual acuity was 1.02 ± 0.45, with an overall improvement of 5 lines postoperatively. Small holes and large holes improved, with an average of 3 versus 7 lines gained, respectively. In this study cohort, favorable anatomical and functional outcomes were achieved without postoperative FDP. These outcomes are comparable to the traditional FDP approach.

Unilateral Macular hole in a patient with Retinitis Pigmentosa treated with cover flap technique with the use of platelet-rich plasma under air tamponade: case report.

The purpose of the study is to show the excellent anatomical result of the inverted flap-assisted technique with PRP under air for retinitis pigmentosa complicated with macular hole. A 32-year-old woman, previously diagnosed with retinitis pigmentosa, was referred to our department complaining of decreased central vision in her LEFT eye for 4 weeks. At the time of presentation, the optical coherence tomography and fundoscopy examination showed the presence of a macular hole of 620 microns in diameter. The closure of the macular hole was observed after the surgical procedure, but endophthalmitis occurred 5 days postoperatively. In our presented case, the cover flap-assisted technique with PRP under air for retinitis pigmentosa complicated with macular hole resulted in excellent anatomical outcomes with unremarkable visual recovery. The physiopathology of full-thickness macular holes in RP patients remains still not fully elucidated. Pars plana vitrectomy with the adjunct of highly concentrated P-PRP have shown successful results.

Relaxing radial retinal incisions for the treatment of persistent macular holes.

Various surgical techniques have been described for managing persistent macular holes after an unsuccessful vitrectomy with internal limiting membrane (ILM) peeling. However, the closure and functional improvement rates after these procedures are limited. Therefore, the aim of this study was to evaluate the usefulness of radial retinal incisions (retinotomies) in eyes with persistent large macula holes despite previous vitrectomy with ILM peeling. In a retrospective case series, closure rate and best-corrected visual acuity (BCVA) were evaluated in eyes with persistent macular holes after an unsuccessful vitrectomy that included posterior vitreous detachment and ILM peeling. 22 eyes of 22 patients (10 men and 12 women) underwent re-vitrectomy with radial retinal incisions. All the patients had undergone an unsuccessful surgery before. Small-incision re-vitrectomy with radial retinal incisions (retinotomies) and air tamponade was performed. For all eyes, high-definition SD-OCT scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery; 1 week and 1 month after surgery; and at final follow-up. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best-corrected visual acuity (BCVA) in logMAR and Snellen at baseline, 1 and 4 months after operation, and at the final follow-up visit were analyzed. The mean baseline macular hole diameter was 668.5 ± 226.8 μm. At the final examination, 16 (72.72%) of the 22 macula holes were closed. Visual acuity increased in 17 eyes, was stable in 3 eyes, and decreased in 2 eyes owing to central retinal atrophy in both. The mean BCVA increased from logMAR 1.04 ± 0.29 at baseline to 0.57 ± 0.31 (Snellen 0.11 ± 0.05 to 0.33 ± 0.18). In all successful cases, macula hole closure was attained after 3 days, and none of the eyes showed macula hole recurrence. The results of this limited case series suggest that radial retinal incisions of the rim in persistent macula holes after initial surgery with ILM peeling increase the success rate of macula hole closure and results in a relevant increase in BCVA. However, as the number of eyes included in this series is limited, the results must be confirmed in a study with a larger sample size.

Surgical treatment of idiopathic macular holes with a fovea-sparing technique and 20% SF6 gas tamponade

Purpose: To assess the macular hole (MH) closure rate and final visual acuity after idiopathic MH treatment with a modified fovea-sparing technique and 20% SF6 gas tamponade. Material and Methods: Fifteen patients (16 eyes; 12 women and 3 men; mean age (standard deviation or SD), 65.5 (5.90 years)) with Gass stage 2 to stage 4 MHs were involved in the study. Before surgery, mean best-corrected visual acuity (BCVA) (SD) was 0.15 (0.09), and mean MH diameter (SD), 437.2 (164.7) µm. Patients underwent surgical treatment with the modified fovea-sparing technique and 20% SF6 gas tamponade of two-week duration and were instructed to maintain a face-down position for a week after surgery. Results: At 1 month after the first surgery, MHs were closed in 11/16 eyes (68.75%). In addition, mean BCVA (SD) in eyes with closed MHs improved significantly from 0.15 (0.09) to 0.48 (0.16) (р = 0.000000). Of the five eyes in which the MH had failed to close after primary fovea-sparing surgery, two received a gas fluid exchange gas tamponade with 15% С3F8, and these patients were advised to maintain a face down position for 3 more weeks. In addition, in another two eyes, the vitreous cavity was revised, and the internal limiting membrane (ILM) was removed by a conventional technique with 15% С3F8 gas tamponade. Moreover, one patient rejected repeat intervention. In the four eyes in which the MH had failed to close after primary fovea-sparing surgery, after a repeat intervention, the MH was closed, and mean BCVA (SD) improved to 0.35 (0.04). There was no significant difference between the eyes in which the MH failed to close and the eyes in which the MH did close after primary surgery in terms of mean MH size (SD) (455 (203) µm versus 415 (155) µm, р = 0.66) or MH duration. Conclusion: A long gas tamponade (longer than 1 week) is required to improve the closure rate with the fovea-sparing ILM peeling technique for idiopathic MHs.

Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2: A Global Multicenter Study

To report on macular hole repair in macular telangiectasia type 2 (MacTel2). Global, multicenter, retrospective case series. Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH). Standardized data collection sheet distributed to all surgeons. Anatomic closure and visual outcomes of MTMH. Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 ± 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 ± 159.4 μm (range, 34-573 μm). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 ± 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 ± 0.552 logMAR. MHD was 440.8 ± 175.5 μm (range, 97-697 μm), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 ± 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 ± 0.391 logMAR. MHD was 390.2 ± 203.7 μm (range, 132-687 μm). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 ± 0.246 logMAR (P=0.08). Visual acuity improved at least 2 lines in 25%. Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

NONSURGICAL RESOLUTION OF FULL-THICKNESS MACULAR HOLES WITHOUT VITREOMACULAR TRACTION.

The purpose of this study was to report a case series of full-thickness macular holes without vitreomacular traction that resolved without surgery. This study is a retrospective case series of 11 patients who demonstrated closure of full-thickness macular holes without surgical intervention. All full-thickness macular holes closed, with all patients having improvement in visual acuity. All but one of the cases had visual acuity better than 20/40 at last recorded visit. Most cases presented with associated epiretinal membrane (73%), cystoid changes (64%), defects <150 μ m (80%), and resolved within 2 months (91%). Topical anti-inflammatory drops were used in 7 of 11 cases, and dorzolamide was used in one case. Full-thickness macular holes can develop in eyes without the presence of vitreomacular traction. Topical therapy without vitrectomy may be particularly helpful in closure of full-thickness macular holes with associated cystoid macular edema. Holes with a lamellar hole component may spontaneously resolve as part of a retinal remodeling process.