Closure of Macular Holes With Topical Therapy

Abstract

Purpose: To report the results of a nonsurgical approach to repair macular holes (MHs). Methods: A retrospective chart review of consecutive patients with MHs from 2018 to 2021 was performed. Topical therapy consisted of a steroidal agent, a nonsteroidal agent, and a carbonic anhydrase inhibitor. Data collected included the size, stage, and duration of the MH; topical agents used and the duration; lens status; and complications. Macular edema was graded on a scale ranging from 0 (no edema) to 4 (large amount of edema) and recorded. Before and after MH closure, the best-corrected visual acuity (BCVA) was measured and converted to logarithm of the minimum angle of resolution (logMAR) notation. Spectral-domain optical coherence tomography was performed. Results: Seven (54%) of the 13 eyes initially treated topically experienced successful MH closure. Small holes (<230 µm) with a better initial BCVA (0.474 logMAR vs 0.796 logMAR) were more likely to respond favorably to topical therapy (mean 121 µm vs 499 µm). In addition, holes with less surrounding edema responded better. All holes not responding to topical therapy were subsequently closed with pars plana vitrectomy å, membrane peeling, and fluid–gas exchange. Conclusions: Topical therapy is a reasonable first-line treatment for MHs, with a better than 50% success rate. This is especially true for small early-onset holes with minimal or no edema. Surgery still had a high success rate after a 1- to 3-month delay while the MH was treated with eyedrops.

Idiopathic Macular Hole: Algorithm for Nonsurgical Closure Based on Literature Review

“…Forty-nine studies had complete data with a total of 181 eyes forming the basis of our analysis [Table 2]. [ 18 ][ 19 ][ 20 ][ 21 ][ 22 ][ 23 ][ 24 ][ 25 , 26 , 27 , 28 ][ 29 ][ 30 ][ 31 ][ 32 ][ 33 ][ 34 ][ 35 ][ 36 ][ 37 ][ 38 ][ 39 ][ 40 ][ 41 ][ 42 ][ 43 ][ 44 ][ 45 ][ 46 ][ 47 ][ 48 ][ 49 ][ 50 ][ 51 ][ 52 ][ 53 ][ 54 ][ 55 ][ 56 ] Mean vision improved significantly ( P 0.005) from 20/65 to 20/41 over a mean follow-up of two years. The median diameter of IFTMH was 166 with 81.1% being categorized as small holes.…”

Dexamethasone Intravitreal Implant to Treat Persistent Full-Thickness Macular Hole

“…Previous studies reported cases of FTMH closure after treatment with topical steroids and NSAIDs, with most holes having elevated, edematous edges and with the presence of intraretinal cystoid spaces, suggesting an inflammatory trigger as the causative failure mechanism. 16 –20 A recent study by Bonnell et al 18 described for the first time the use of a dexamethasone implant for the treatment of an FTMH. 21 The authors presented the case of a 79-year-old man presenting with a small (134 µm) FTMH that initially closed with steroids and NSAIDs but reopened after the medication was tapered.…”