Macular Hole Closure with Medical Treatment

Sokol, Jared T.; Schechet, Sidney A.; Komati, Rahul; Eliott, Dean; Vavvas, Demetrios G.; Kaplan, Richard; Ittiara, Shaun; Farooq, Asim V.; Sheth, Veeral; MacCumber, Mathew W.; Ke, Rhona; Gentile, Ronald C.; Skondra, Dimitra

doi:10.1016/j.oret.2020.11.018

Cited by 13 publications

(11 citation statements)

References 5 publications

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“…An alternative hypothesis is that the medically treated MHs would have spontaneously closed even without the eyedrops. A recent review 9 reported that the incidence of spontaneous closure was between 4% and 11.5% and that spontaneously closed full-thickness MHs were most commonly small (<250 µm) and without vitreomacular traction, similar to those in most of our patients. Our closure rate of 54% exceeds the potential spontaneous closure rate.…”

Section: Discussionsupporting

confidence: 84%

“…Our success rate with topical therapy does not approach that of surgical success rates; however, topical therapy avoids the risks and morbidity of surgery, which is why all 13 patients initially chose topical therapy over surgery. Unlike in the Sokol et al 9 study, the MH did not reopen in any of our 5 patients who had more than 1 year of follow-up. In a study by Niffenegger et al, 10 topical therapy to treat secondary MHs, mostly after retinal detachment surgery, was successful in 8 (89%) of 9 eyes.…”

Section: Discussioncontrasting

confidence: 83%

“…The mechanism of action of topical therapy is not obvious. In all successfully closed MHs in our study, there was little to no macular edema surrounding the edge of the hole, as was reported by Sokol et al 9 Although their paper included a figure of an MH with no edema that was subsequently closed with topical therapy, the authors still proposed the hydration theory as the cause of the hole and the reason for its closure. Our findings are consistent with this.…”

Section: Discussionsupporting

confidence: 78%

“…These case reports did not address the closure rate. At the time of the previous case series by Sokol et al, 9 the success rate of topical therapy for primary MHs was not known because the denominator was not known. Although small, our study provides a denominator, finding a closure rate of 54%.…”

Section: Discussionmentioning

confidence: 99%

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Closure of Macular Holes With Topical Therapy

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Avetisjan

Shaya

2022

Journal of VitreoRetinal Diseases

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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.

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Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 83%

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Closure of Macular Holes With Topical Therapy

Small

Avetisjan

Shaya

2022

Journal of VitreoRetinal Diseases

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“…Recently, Sokol et al described a case series of patients with idiopathic macular holes who were treated using non-invasive drop therapy consisting of a topical steroid, a non-steroidal anti-inflammatory agent, and a carbonic anhydrase inhibitor [ 29 ]. Patient B received a drop therapy regimen as described above for seven months in the right eye, resulting in an improvement in visual acuity from 20/60 to 20/40.…”

Section: Discussionmentioning

confidence: 99%

Use of OCT Angiography to Diagnose and Manage Atypical Presentations of Macular Telangiectasia Type 2

Moir

Amin

Khanna

et al. 2022

IJMS

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Macular telangiectasia Type 2 (MacTel) is a bilateral acquired retinal disease characterized by both vascular changes and atrophy of the retina. The purpose of this case series is to highlight the use of optical coherence tomography angiography (OCTA) as a non-invasive imaging modality to distinguish atypical MacTel from other macular conditions with similar presentations. We performed a retrospective review of patients referred to our academic retinal practice with unconfirmed or misdiagnosed MacTel between July 2017 and July 2021. Patients’ OCTA imaging findings were reviewed to guide the appropriate diagnosis and management of atypical MacTel. Fifteen eyes from eight patients were included in this study. Six patients were referred with previous diagnoses of either full-thickness macular hole, lamellar hole, vitreomacular traction (VMT), postoperative cystoid macular edema (CME), or diabetic macular edema (DME). Two patients were referred to us to confirm the diagnosis of MacTel. OCTA revealed telangiectatic vessels in the temporal parafovea of all 15 eyes. OCTA also highlighted previously undiagnosed subretinal neovascularization (SRNV) in seven eyes. OCTA imaging is a valuable imaging modality to distinguish MacTel from other macular conditions, whose treatment courses vary substantially. Due to its ease of use, it holds immense potential in the future as treatments for non-proliferative MacTel emerge.

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Macular Hole Surgery

Iezzi

Ferenchak

2022

Albert and Jakobiec's Principles and Practice of Ophthalmology

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Macular Hole Closure with Medical Treatment

Cited by 13 publications

References 5 publications

Closure of Macular Holes With Topical Therapy

Closure of Macular Holes With Topical Therapy

Use of OCT Angiography to Diagnose and Manage Atypical Presentations of Macular Telangiectasia Type 2

Macular Hole Surgery

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