<p>Literature Review of Surgical Treatment in Idiopathic Full-Thickness Macular Hole</p>

Abstract

Purpose To summarize current surgical techniques for treating primary macular holes (MHs). Methods We reviewed publications detailing surgical approaches to primary MHs, briefly described their protocols, and outlined their results. Results Currently, the technique for primary MH repair is pars plana vitrectomy, removing the posterior cortical vitreous, stripping the epiretinal membranes, and ending with intraocular gas tamponade. The evident benefit of peeling off the internal limiting membrane (ILM) was clearly shown for MHs at stages 2 to 4 by achieving an anatomical closure rate of >90%, even in large MH up to 650 µm. Newer MH surgical techniques include modification of ILM flap techniques, placing an autologous scaffolding of tissue within the hole, and cell therapy has shown to increase the closure rate of large and chronic macular holes, resulting in modest functional improvement in complicated MHs. Conclusion Since the turn of the century, the success rate of modern macular surgery has increased, even for large and chronic MHs. There seems to be no limit to novel concepts in MH surgery, which range from anatomical closure to those proposing natural restoration of visual function via stem cell therapy.

Intraoperative Observation of a Macular Holes Using Optical Coherence Tomography

“…Internal limiting membrane (ILM) peeling has also been proven to be beneficial for stage 2 to 4 MHs. 2 , 5 …”

Face-Down Posture versus Non-Face-Down Posture following Large Idiopathic Macular Hole Surgery: A Systemic Review and Meta-Analysis

“…This discrepancy between the anatomical and functional results can be explained by several assumptions. Many factors are associated with visual success after IMH surgery, including preoperative VA, IMH size, duration of IMH before surgery, shape of macular closure, and the macular-hole index, defined as the ratio of the hole height to the base diameter [ 42 , 43 , 44 ]. Owing to the insufficient data in our included studies, we could not eliminate the confounding effects of associated factors and predict the potential role of the FDP in the process of visual recovery.…”

Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair

“…Patients with secondary FTMH were excluded from the study, namely: high myopia, macular schisis, macular telangiectasia, wet age-related macular degeneration, previous pars plana vitrectomy (e.g. for vitreomacular pathologies or retinal detachment), and blunt trauma [ 1 , 3 ].…”

“…If the posterior vitreous detachment is incomplete, epiretinal cell proliferation and fibrosis are essential parts of the pathogenesis too [ 2 ]. Secondary FTMH is related to other pathologic features such as high myopia, macular schisis, macular telangiectasia, wet age-related macular degeneration, surgical or ocular trauma without any preexisting or concurrent vitreomacular traction [ 1 , 3 ]. Primary FTMH is diagnosed in 86 to 92 % of cases [ 4 ].…”