Macular Hole Closure Research Articles

Delayed Spontaneous Closure of a Full Thickness Myopic Macular Hole with Good Visual Recovery

Purpose: To present the longitudinal progression of a myopic macular hole with eventual closure and excellent visual recovery over a decade after initial full-thickness hole formation. Methods: The patient was monitored using time-domain and spectral-domain optical coherence tomography images over 16 years. Results: A 68-year-old man with high myopia was referred for surgical evaluation of a full-thickness macular hole and retinal detachment of his left eye, which were repaired. At initial presentation, the fellow eye demonstrated a lamellar hole, which eventually also progressed to become a full-thickness macular hole. The patient subsequently declined surgery and was observed semiannually over the course of 16 years. At 10 years following initial injury, the full-thickness macular hole closed spontaneously. The visual recovery was excellent with an acuity of 20/25. Conclusion: Although surgical intervention remains the mainstay of treatment for macular holes, patients who are not surgical candidates may still have good visual and anatomic outcomes even long after initial hole formation. Lamellar hole epiretinal proliferation material is frequently seen in myopic full-thickness macular holes and may be associated with eventual delayed hole closure due to their slow progression.

Delayed closure of a full-thickness macular hole following pars plana vitrectomy with ILM flap

Purpose: Our aim is to describe a patient with delayed closure of a stage 3 full thickness macular hole after pars plana vitrectomy. Methods: A retrospective case report. Details of the case were obtained from the electronic patient record system, Medisoft. Results: A 65-year-old male was referred with a left stage 3 full thickness macular hole measuring 720 microns and visual acuity of 6/36. He underwent phaco-vitrectomy, ILM peel with an inverted ILM flap and C3F8 gas tamponade. 7 weeks after surgery, the macular hole was smaller at 196 microns but remained open. The patient was listed for repeat surgery, however another 13 weeks later the full thickness macular hole demonstrated type 2 closure without further intervention. Discussion/conclusion: Delayed macular hole closure after pars plana vitrectomy is rare. In cases where there has been a substantial decrease in the size of a full thickness macular hole after surgery without full closure, a short period of observation to allow for further closure may be appropriate before reconsidering surgery.

MicroRNA-152-3p and MicroRNA-196a-5p Are Downregulated When Müller Cells Are Promoted by Components of the Internal Limiting Membrane: Implications for Macular Hole Healing.

Müller cells play a critical role in the closure of macular holes, and their proliferation and migration are facilitated by the internal limiting membrane (ILM). Despite the importance of this process, the underlying molecular mechanism remains underexplored. This study investigated the effects of ILM components on the microRNA (miRNA) profile of Müller cells. Rat Müller cells (rMC-1) were cultured with a culture insert and varying concentrations of ILM component coatings, namely, collagen IV, laminin, and fibronectin, and cell migration was assessed by measuring cell-free areas in successive photographs following insert removal. MiRNAs were then extracted from these cells and analyzed. Mimics and inhibitors of miRNA candidates were transfected into Müller cells, and a cell migration assay and additional cell viability assays were performed. The results revealed that the ILM components promoted Müller cell migration (p < 0.01). Among the miRNA candidates, miR-194-3p was upregulated, whereas miR-125b-1-3p, miR-132-3p, miR-146b-5p, miR-152-3p, miR-196a-5p, miR-542-5p, miR-871-3p, miR-1839-5p, and miR-3573-3p were significantly downregulated (p < 0.05; fold change > 1.5). Moreover, miR-152-3p and miR-196a-5p reduced cell migration (p < 0.05) and proliferation (p < 0.001), and their suppressive effects were reversed by their respective inhibitors. In conclusion, miRNAs were regulated in ILM component-activated Müller cells, with miR-152-3p and miR-196a-5p regulating Müller cell migration and proliferation. These results serve as a basis for understanding the molecular healing process of macular holes and identifying potential new target genes in future research.

Face-down positioning or posturing after macular hole surgery.

Face-down positioning or posturing after macular hole surgery.

Anatomical and functional results after vitrectomy with conventional ILM peeling versus inverted ILM flap technique in large full-thickness macular holes

BackgroundAim of the study was to compare success rate and functional outcome following pars plana vitrectomy (PPV) with conventional internal limiting membrane (ILM) peeling versus ILM flap technique for full-thickness idiopathic macular holes (FTMH).MethodsRetrospective analysis of consecutive eyes with FTMH having undergone vitrectomy with sulfur hexafluoride (SF6) endotamponade 25% at the University Medical Center Rostock, Germany (2009–2020). Eyes were divided according to applied surgical technique (ILM peeling [group P] versus ILM flap [group F]). Inclusion criteria were macular hole base diameters (MH-BD) ≥ 400 μm plus axial length ≤ 26.0 mm. Each group was divided into two subgroups based on macular hole minimum linear diameter (MH-MLD): ≤ 400 μm and > 400 μm. Exclusion criteria were FTMH with MH-BD < 400 μm, trauma, myopia with axial length > 26.0 mm or macular schisis. Demographic, functional, and anatomical data were obtained pre- and postoperatively. Preoperative MH-BD and MH-MLD were measured using optical coherence tomography (OCT; Spectralis®, Heidelberg Engineering GmbH, Heidelberg, Germany). Main outcome parameter were: primary closure rate, best-corrected visual acuity (BCVA), and re-surgery rate.ResultsOverall 117 eyes of 117 patients with FTMH could be included, thereof 52 eyes underwent conventional ILM peeling (group P) and 65 additional ILM flap (group F) technique. Macular hole closure was achieved in 31 eyes (59.6%) in group P and in 59 eyes (90.8%) in group F (p < 0.001). Secondary PPV was required in 21 eyes (40.4%) in group P and in 6 eyes (9.2%) in group F. Postoperative BCVA at first follow-up in eyes with surgical closure showed no significant difference for both groups (MH-MLD ≤ 400 μm: p = 0.740); MH-MLD > 400 μm: p = 0.241).ConclusionAnatomical results and surgical closure rate following ILM flap technique seems to be superior to conventional ILM peeling for treatment of FTMH.

FULL-THICKNESS MACULAR HOLE CLOSURE WITH TOPICAL MEDICAL THERAPY.

To examine the efficacy and clinical characteristics of successful full-thickness macular hole closure with topical therapy. Retrospective case series of full-thickness macular holes managed by a single retinal physician (DS) diagnosed and treated from 2017 to 22. Of 168 patients with full-thickness macular holes, 71 patients were started on steroid, carbonic anhydrase inhibitor, and nonsteroidal antiinflammatory (NSAID) drops. 49 patients (mean 67 years, 59% women) were included in the analysis, and 22 patients were excluded for poor follow-up. In total, 7/49 were secondary post-PPV holes and 42/49 were idiopathic. In addition, 18/49 eyes (36.7%) achieved closure on topical therapy, of which 13 were idiopathic. Hole size was directly correlated with odds of closure: for every 10 μm decrease in size and odds of closure increased by 1.2× ( P = 0.001, CI 1.1-1.4). Average time to closure was 107.2 days (range 20-512 days) and was not correlated with hole size ( P = 0.217, CI -0.478 to +1.938). The presence of VMT was found to be inversely related to successful closure (OR 6.1, P = 0.029, CI 1.2-31.3). There was no significant difference in final best-corrected visual acuity for eyes undergoing primary pars plana vitrectomy versus those trialing drops before undergoing pars plana vitrectomy ( P = 0.318, CI -0.094 to +0.112). In the first study to date to report the overall efficacy and clinical characteristics of successful macular hole closure with topical therapy, drops achieved an overall closure rate of 36.7%, with higher efficacy in smaller holes and those without VMT. Rates of MH narrowing and reduction in central foveal thickness acted as predictors of effectiveness of drop therapy.

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.

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.

Fibrin-Glue-Assisted Surgery for Idiopathic Macular Holes

ABSTRACT Pars plana vitrectomy (PPV) with internal limiting membrane peeling (ILMP) and gas tamponade has been the standard of care for idiopathic macular holes (MHs). However, the use of tamponades like intraocular gases has their associated complications and more importantly a need for postoperative positioning which can be a challenge in elderly and people with orthopaedic problems. This study describes a novel surgical technique of utilising fibrin glue to obviate the problems associated with conventional gas tamponade and also to help in avoiding any postoperative positioning. Methods This pilot clinical trial included 10 eyes of 10 patients with idiopathic MH, where PPV along with ILMP was done. Fibrin glue was used as a tamponade, and no postoperative positioning was given to any patient. The primary outcome measure was successful anatomical closure of the MH. The secondary outcome measures were postoperative improvement in best-corrected visual acuity (BCVA) and any complications of the procedure. Results The median age of patients was 62.5 years. Eight eyes were pseudophakic and two were phakic. The mean basal diameter of the MH was 1193 microns. The mean minimal linear diameter was 652 microns. Successful anatomic closure of MH was achieved in eight cases. The median BCVA improved from a Snellen equivalent of 20/100 preoperatively to 20/60 at 1 month postoperatively. The median follow-up period was 4 months. Conclusion The findings of this study suggest that the use of fibrin glue can be useful in patients where postoperative positioning is difficult.

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.

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.

Full Thickness Macular Hole after Laser Assisted in Situ Keratomileusis: A Case Report and Review of the Literature

Purpose: While myopia is known to be a risk factor for Macular Hole (MH) formation, there have been no reviews evaluating the association between LASIK procedure and MH development. Our case series and literature review examine the clinical characteristics and visual outcomes of patients who developed MH following LASIK. Methods: A retrospective chart review was completed for two patients who developed MH following LASIK. For the literature review, Ovid/MEDLINE was searched for all patients who developed MH following LASIK. Results: Two patients with history of LASIK procedure presented with unilateral MH. Both patients were only mildly myopic and lacked other risk factors for MH. They both underwent pars plana vitrectomy, Internal Limiting Membrane (ILM) peel with ILM flap draped over and tucked into the macular hole, followed by 20% sulfur hexafluoride tamponade. Both cases had MH closure and improvement in final visual acuity. The literature review included 25 cases and 27 eyes with MH following LASIK. Twenty-four cases were female and myopic, and the mean refraction was -8.64 D. The average duration from LASIK to MH development was 15.3 months. Mean preoperative best corrected visual acuity was Snellen 20/235. Seventy-seven percent (21/27) of eyes underwent vitrectomy, with a MH closure rate of 100% and final visual acuity of Snellen 20/89. Conclusion: Myopia is a known risk factor for MH formation. However, LASIK procedure may introduce an additional increased risk of MH formation in myopic eyes. Thus, although rarely reported, patients considering LASIK should be counselled on this potential risk.

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.

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.

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.