Materiały źródłowe

• #1 Macular Hole: Symptoms, Causes, & Treatment

  https://my.clevelandclinic.org/health/diseases/14208-macular-hole

  A macular hole is a full-thickness defect in your macula, part of your retina. Surgery to treat a macular hole has high success rates if the hole is small. […] The most common treatment for macular holes is a procedure called a vitrectomy. A vitrectomy is a surgery during which a retina specialist removes the vitreous gel of your eye. Your surgeon, an ophthalmologist trained in retina surgery, may also remove any bits of tissue (membranes) that may be putting tension on your macula. […] Your surgeon will put a sterile gas into your eye to keep pressure on the hole until it heals. You may have to stay in a facedown position for one to seven days to keep the bubble in place so the hole will close. […] If you have a small hole, your retina specialist may suggest watching and waiting rather than treating it. Sometimes an early-stage macular hole will close on its own. […] The success rate for vitrectomy surgeries is over 90%. The surgery is most successful when the hole is smaller and more recent. You may regain most or some of your lost vision. […] If you get treatment sooner, or if the hole is small, your prognosis (outlook) is good.

• #2 Macular Hole | National Eye Institute

  https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-hole

  Treatment: Close observation for small holes, surgery for most cases […] If a macular hole is affecting your vision, you’ll probably need a type of surgery called vitrectomy to fix the hole and prevent permanent vision loss. […] During a vitrectomy, the doctor removes the vitreous and some tissues on the surface of the macula and injects a gas bubble into your eye. […] Treatment works best when doctors catch macular holes early, so it’s important to talk to your eye doctor right away if you notice symptoms of a macular hole.

• #3 Diagnosis and Treatment – Moorfields Private

  https://moorfields.nhs.uk/private/eye-conditions-and-treatments/macular-hole/diagnosis-and-treatment

  The only way to treat a macular hole is by having an operation. Eye drops or glasses are ineffective. […] An alternative to surgery is a new therapy called ocriplasmin which is a drug injected into the eye. Although an initial study has shown that this treatment may be beneficial in selected cases, it is still undergoing clinical assessment. Generally, it is not as reliable as surgery and the majority of patients treated with ocriplasmin will go on to have surgery. This option can be discussed with your consultant. […] The operation to repair your macular hole is called a vitrectomy and usually takes about an hour. Whichever form of anaesthetic you chose, we will give you eye drops before your operation to enlarge your pupils. The surgeon will then make tiny openings in your eye and remove the vitreous (the jelly-like substance) from inside. Your eye is then filled with a bubble of special gas, which presses against the macula and seals the hole.

• #4 Macular Hole

  https://www.asrs.org/patients/retinal-diseases/4/macular-hole

  Vitrectomy is the most common treatment for macular holes. In this surgical procedure, the vitreous gel is removed to stop it from pulling on the retina, and most commonly a gas bubble is placed in the eye to gently hold the edges of the macular hole closed until it heals. […] Another potential treatment for some patients with macular holes is the injection of ocriplasmin (Jetrea) into the vitreous. This drug helps to relieve vitreous traction on some macular holes. […] In cases where the macular hole is very small and does not have a large impact on your vision, your doctor may not recommend any treatment at all. He or she may simply observe and track the macular holes progression or natural healing. In this case, it would be important to have regular follow-up eye examinations as determined by your eye doctor to catch and treat any problems early.

• #5

  https://www.aao.org/eye-health/diseases/macular-hole-treatment/?amp=1

  Surgery called vitrectomy is the best way to treat a macular hole. Your ophthalmologist removes the vitreous that is pulling on your macula. Then he or she puts a gas bubble inside the eye. This bubble helps flatten the macular hole and hold it in place while your eye heals. The gas bubble slowly goes away on its own. […] Your vision will improve as the macular hole closes. It may take several months for the hole to finish healing. How much vision you get back depends on the size of your macular hole. It also depends on how long the hole was there before you had surgery. […] Your ophthalmologist will talk about these risks and how vitrectomy surgery may help you.

• #6 Macular Hole treatment at Wills Eye Hospital in Philadelphia PA

  https://www.willseye.org/macular-hole/

  For select patients who have a small macular hole, an in-office injection of a medication called ocriplasmin (Jetrea) into the vitreous gel may be a treatment option. However, for many patients, vitrectomy surgery is required. A vitrectomy is an outpatient surgery usually performed under local anesthesia that consists of removing the vitreous gel that pulled the hole open. In order to seal the hole closed, your doctor will replace the gel with a temporary gas bubble at the time of surgery. This bubble will severely limit the vision in the operated eye for a period of a few weeks, depending upon the type of gas bubble used. The body eventually absorbs this gas bubble and replaces it with natural eye fluids. […] Surgery is highly effective in achieving closure of a macular hole, though certain features including size and how long it has been present will influence the success rate. Occasionally, a hole either doesn’t close or reopens; in such cases additional surgery may be effective. Surgical success may be enhanced if you can position in a face down manner immediately after the operation for a few days, though with our current techniques there is a trend towards reducing or eliminating the need for such positioning.

• #7 Macular Hole: Symptoms, Causes, & Treatment

  https://my.clevelandclinic.org/health/diseases/14208-macular-hole

  A macular hole is a full-thickness defect in your macula, part of your retina. Surgery to treat a macular hole has high success rates if the hole is small. […] The most common treatment for macular holes is a procedure called a vitrectomy. A vitrectomy is a surgery during which a retina specialist removes the vitreous gel of your eye. Your surgeon, an ophthalmologist trained in retina surgery, may also remove any bits of tissue (membranes) that may be putting tension on your macula. […] Your surgeon will put a sterile gas into your eye to keep pressure on the hole until it heals. You may have to stay in a facedown position for one to seven days to keep the bubble in place so the hole will close. […] If you have a small hole, your retina specialist may suggest watching and waiting rather than treating it. Sometimes an early-stage macular hole will close on its own. […] The success rate for vitrectomy surgeries is over 90%. The surgery is most successful when the hole is smaller and more recent. You may regain most or some of your lost vision. […] If you get treatment sooner, or if the hole is small, your prognosis (outlook) is good.

• #8 Study finds medicated eye drops may help close macular holes without surgery – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/research-and-discoveries-articles/2021/january/medication-closes-small-macular-holes

  Medicated drops may help close small macular holes over a two- to eight-week period, allowing some people to avoid surgery to fix the vision problem, a new study suggests. […] For certain patients, medicated drops may heal their macular hole by decreasing inflammation and increasing fluid absorption in the retina, said ophthalmologist and retinal surgeon Dimitra Skondra, MD, PhD, senior author of the study. […] As an alternative to surgery, the researchers prescribed a daily three-drug regimen medications that are FDA-approved and routinely used for other eye conditions consisting of prednisolone or difluprednate, ketorolac or bromfenac and brinzolamide or dorzolamide. […] Using this topical medicated treatment, 12 of the 14 patients had holes that closed within two to eight weeks two to four times faster than spontaneous closure rates of macular holes.

• #9 Medical Management of Full-Thickness Macular Holes – Retina Today

  https://retinatoday.com/articles/2022-apr/medical-management-of-full-thickness-macular-holes

  Topical therapy may be a good option for a subset of patients. […] The standard surgical approach, therefore, centers on relief of traction through pars plana vitrectomy (PPV) with induction of a posterior vitreous detachment (PVD), epiretinal membrane (ERM) peel when relevant, and internal limiting membrane (ILM) peel, followed by gas tamponade and prone positioning. […] Medical management of FTMHs is based on the combined tractional-hydration theory. […] Dehydration of the cystic fluid through use of a retinal pigment epithelium (RPE) pump results in closure of the macular hole, followed by reabsorption of the subretinal fluid. […] Based on the combined tractional-hydration theory of FTMH pathogenesis, several groups have reported individual cases or small case series of FTMH closure with topical therapies.

• #10 AAO Idiopathic Macular Hole Guideline Summary

  https://www.guidelinecentral.com/guideline/10150/

  Careful removal of the internal limiting membrane (ILM) during vitrectomy surgery increases the macular hole closure rate without adversely affecting visual acuity. […] Cataract development or progression is a frequent side effect of vitrectomy surgery to repair macular holes. This risk should be discussed with patients preoperatively, and postoperative monitoring is advised.

• #11 Macular Hole Treatment & Management: Medical Care, Surgical Care, Complications

  https://emedicine.medscape.com/article/1224320-treatment

  Indications for consideration of the surgical management of macular holes are based on the presence of a full-thickness defect. […] Historically, therapy for macular holes has evolved from pharmacologic interventions, such as anxiolytics and vasodilators, to an assortment of surgical techniques, such as cerclage, scleral buckles, direct photocoagulation of the hole edges, and intraocular gas tamponade without the aid of vitrectomy. […] In 1991, Kelly and Wendel demonstrated that vitrectomy, removal of cortical vitreous and epiretinal membranes, and strict face-down gas tamponade could successfully treat full-thickness macular holes. […] The overall results of their initial report were a 58% anatomic success rate and visual improvement of 2 or more lines in 42% of eyes. […] A prospective, randomized, and controlled series by the Vitrectomy for Treatment of Macular Hole Study Group for stage 2, 3, and 4 holes showed that vision was improved in surgically treated eyes compared with observed eyes.

• #12 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  One of the most disruptive innovations in the field was made in 1997 by C. Eckardt, who published the results of macular holes that were treated with vitrectomy plus internal limiting membrane (ILM) peeling. […] A few years later, Michalewska et al described the inverted ILM flap technique, which improved both functional and anatomic outcomes of vitrectomy for FTMHs with a diameter greater than 400 m. […] More recently, Wiedemann provided insight into the mechanisms of ILM peeling, including improved retinal flexibility, better oxygen supply to the inner retina, and, potentially, retinal glial cell proliferation. […] Despite this growing body of work, we have yet to find a definitive solution for macular holes. Many FTMHs that are refractory to conventional management may be less than 400 m, requiring a revised classification scheme and novel treatment options.

• #13 Macular hole repair does not require face-down positioning – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/ophthalmology/news/macular-hole-repair-does-not-require-face-down-positioning/mac-20430610

  Macular hole repair does not require face-down positioning. A retrospective study of 68 eyes (65 patients) indicates that macular hole surgery with broad internal limiting membrane (ILM) peeling, 20% sulfur hexafluoride (SF6) gas and no face-down positioning is highly effective in the surgical treatment of idiopathic macular holes. The method also eliminates the morbidity associated with postoperative face-down positioning. „Closure methods that eliminate the need for face-down positioning and do not compromise closure rates would reduce patient morbidity significantly, improve patient satisfaction and represent a significant advancement in surgery for macular holes,” says Dr. Iezzi. „Although this retrospective study has limitations, our data suggest that by using broad ILM peeling, 20% SF6 gas and no face-down positioning, macular hole closure rates are comparable with or better than those of other closure methods.”

• #14 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  Peeling the internal limiting membrane and epiretinal membranes has become the standard technique to address vitreomacular interface diseases. […] Human amniotic membrane transplant and autologous retinal transplant are recent approaches to the treatment of refractory macular holes. […] Retinal expansion is a valuable technique for macular holes, in which subretinal injection of balanced salt solution creates a macular detachment. […] To determine the appropriate treatment approach for FTMHs, we first measure the hole size and the baseline visual acuity. Based on these criteria, clinicians can decide to monitor, treat medically, or proceed to the OR. A surgical approach to FTMHs has three main objectives: lower the resistance to facilitate the closure with the maculorexis; decrease the size by drying with fluid-air exchange; and provide a gas tamponade (SF6).

• #15 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  At the 2019 Retina World Congress, Tamer H. Mahmoud, MD, PhD, presented on autologous retinal transplantation (ART) for macular holes, adding to our growing armamentarium. Human amniotic membrane transplant (hAM) is yet another recent technique that has made the treatment of recurrent and refractory FTMHs possible. […] A large retrospective case series of 130 patients undergoing ART for the repair of primary and refractory macular holes showed good anatomic and functional outcomes. […] Several alternative surgical options may prove useful for certain refractory macular holes, such as various ILM flap techniques, retinal expansion, lens capsule transplantation, blood products, and macular buckling. […] The retinal expansion technique is another valuable alternative to macular hole closure. Subretinal injection of balanced salt solution creates a macular detachment, which may lead to hole closure. […] Alezzandrini et al published a study to compare the functional and anatomic outcomes at 24 months of eyes with a primary FTMH that failed to close after surgery and were treated with either an ART of ILM (ART-ILM) or the retinal expansion technique.

• #16 Tips for Managing Complicated Macular Holes | Retinal Physician

  https://retinalphysician.com/issues/2024/julyaugust/tips-for-managing-complicated-macular-holes/

  Recent advancements in surgical techniques, such as autologous retinal transplant (ART) and amniotic membrane graft (AMG), have improved outcomes for treating complicated macular holes, particularly those that are refractory to initial surgery. […] Scaffold-based approaches like ART and AMG, along with expansion-based techniques involving subretinal blebs, offer tailored solutions to achieve better anatomic and functional outcomes in eyes with large or complicated macular holes. […] The retracting-door internal limiting membrane (ILM) flap technique helps preserve ILM for potential future use and reduces the risk of flap displacement, making it a useful method for first-time macular hole surgeries. […] An area of focus over the past decade has been to improve surgical techniques in eyes with complicated macular holes wherein prognosis for successful macular hole closure and improved visual acuity is less favorable.

• #17 Macular Hole | Eye Disorders | Ophthalmology | Area of Care | SUNY Downstate

  https://www.downstate.edu/patient-care/find-treatment/areas-of-care/ophthalmology/eye-disorders/macular-hole.html

  How is a macular hole treated? […] Although some macular holes can seal themselves and require no treatment, surgery is necessary in many cases to help improve vision. In this surgical procedure–called a vitrectomy–the vitreous gel is removed to prevent it from pulling on the retina and replaced with a bubble containing a mixture of air and gas. The bubble acts as an internal, temporary bandage that holds the edge of the macular hole in place as it heals. Surgery is performed under local anesthesia and often on an out-patient basis. […] Following surgery, patients must remain in a face-down position, normally for a day or two but sometimes for as long as two-to-three weeks. This position allows the bubble to press against the macula and be gradually reabsorbed by the eye, sealing the hole. As the bubble is reabsorbed, the vitreous cavity refills with natural eye fluids.

• #18 Macular Hole | Eye Disorders | Ophthalmology | Area of Care | SUNY Downstate

  https://www.downstate.edu/patient-care/find-treatment/areas-of-care/ophthalmology/eye-disorders/macular-hole.html

  What if I cannot remain in a face-down position after the surgery? […] If you cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. People who are unable to remain in a face-down position for this length of time may not be good candidates for a vitrectomy. However, there are a number of devices that can make the „face-down” recovery period easier on you. There are also some approaches that can decrease the amount of „face-down” time. Discuss these with your doctor.

• #19 Macular Hole | Retina Care Center

  https://www.retinacarecenternj.com/macular-hole/

  Macular holes typically affect elderly patients and are caused by progressive vitreoretinal traction at the center of the retina or macula. […] The treatments for macular holes include: […] Surgical intervention called pars plana vitrectomy with gas injection is necessary to close full thickness macular holes. This is done in order to improve visual acuity in patient.

• #20 Macular hole repair does not require face-down positioning – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/ophthalmology/news/macular-hole-repair-does-not-require-face-down-positioning/mac-20430610

  Macular hole repair does not require face-down positioning. A retrospective study of 68 eyes (65 patients) indicates that macular hole surgery with broad internal limiting membrane (ILM) peeling, 20% sulfur hexafluoride (SF6) gas and no face-down positioning is highly effective in the surgical treatment of idiopathic macular holes. The method also eliminates the morbidity associated with postoperative face-down positioning. „Closure methods that eliminate the need for face-down positioning and do not compromise closure rates would reduce patient morbidity significantly, improve patient satisfaction and represent a significant advancement in surgery for macular holes,” says Dr. Iezzi. „Although this retrospective study has limitations, our data suggest that by using broad ILM peeling, 20% SF6 gas and no face-down positioning, macular hole closure rates are comparable with or better than those of other closure methods.”

• #21 Macular hole repair does not require face-down positioning – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/ophthalmology/news/macular-hole-repair-does-not-require-face-down-positioning/mac-20430610

  „Visual acuity improved in all patients who achieved successful anatomical closure,” says Dr. Iezzi, „which was approximately 95%.” This study shows that no-face-down macular hole repair is noninferior to face-down procedures, and vision can improve even when the macular hole has been present for many years.

• #22 Macular Hole | Eye Disorders | Ophthalmology | Area of Care | SUNY Downstate

  https://www.downstate.edu/patient-care/find-treatment/areas-of-care/ophthalmology/eye-disorders/macular-hole.html

  Maintaining a face-down position is crucial to the success of the surgery. Because this position can be difficult for many people, it is important to discuss this with your doctor before surgery. […] What are the risks of surgery? […] The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated. […] How successful is this surgery? […] Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.

• #23 Macular Hole Treatment | Northern California Advanced Surgery Center

  https://www.norcalasc.com/conditions/macular-hole

  If you cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. People who are unable to remain in a face-down position for this length of time may not be good candidates for a macular hole surgery. However, there are a number of devices that can make the face-down recovery period easier on you. There are also some approaches that can decrease the amount of face-down time. Discuss these with your doctor.

• #24 Macular Hole

  https://www.asrs.org/patients/retinal-diseases/4/macular-hole

  Vitrectomy is the most common treatment for macular holes. In this surgical procedure, the vitreous gel is removed to stop it from pulling on the retina, and most commonly a gas bubble is placed in the eye to gently hold the edges of the macular hole closed until it heals. […] Another potential treatment for some patients with macular holes is the injection of ocriplasmin (Jetrea) into the vitreous. This drug helps to relieve vitreous traction on some macular holes. […] In cases where the macular hole is very small and does not have a large impact on your vision, your doctor may not recommend any treatment at all. He or she may simply observe and track the macular holes progression or natural healing. In this case, it would be important to have regular follow-up eye examinations as determined by your eye doctor to catch and treat any problems early.

• #25 Diagnosis and Treatment – Moorfields Private

  https://moorfields.nhs.uk/private/eye-conditions-and-treatments/macular-hole/diagnosis-and-treatment

  The only way to treat a macular hole is by having an operation. Eye drops or glasses are ineffective. […] An alternative to surgery is a new therapy called ocriplasmin which is a drug injected into the eye. Although an initial study has shown that this treatment may be beneficial in selected cases, it is still undergoing clinical assessment. Generally, it is not as reliable as surgery and the majority of patients treated with ocriplasmin will go on to have surgery. This option can be discussed with your consultant. […] The operation to repair your macular hole is called a vitrectomy and usually takes about an hour. Whichever form of anaesthetic you chose, we will give you eye drops before your operation to enlarge your pupils. The surgeon will then make tiny openings in your eye and remove the vitreous (the jelly-like substance) from inside. Your eye is then filled with a bubble of special gas, which presses against the macula and seals the hole.

• #26 Macular Hole Treatment & Management: Medical Care, Surgical Care, Complications

  https://emedicine.medscape.com/article/1224320-treatment

  Ocriplasmin […] In October 2012, ocriplasmin (Jetrea) was approved by the US Food and Drug Administration (FDA) for the treatment of vitreomacular adhesion. Ocriplasmin is a recombinant proteolytic enzyme that underwent study by the MIVI-TRUST study group. This injectable medication provides a nonsurgical means of treating macular holes. […] A systematic meta-analysis of 5 randomized controlled trials was published in 2020 and involving 1067 participants. This analysis showed that ocriplasmin treatment did result in better vision than controls at 6 months with a lowered rate of vitrectomy and increased macular hole closure. […] Topical Medical Treatment of Full Thickness Macular Holes […] Successful closure was achieved in 8 of the 9 eyes with topical therapy alone. […] The potential for better vision, as well as the 12% chance that the fellow eye will develop another macular hole, has prompted ophthalmologists to seek a viable treatment for this condition.

• #27 Macular Hole Medication: Ophthalmic, Other

  https://emedicine.medscape.com/article/1224320-medication

  The first protease to treat vitreomacular adhesions associated with macular hole was approved by the FDA in October 2012. Nonsurgical closure of the macular hole was shown in 40.6% of patients treated with an intravitreal injection of ocriplasmin compared with 10.6% who received placebo. […] However, there is evidence of potential retinal toxicity associated with the use of ocriplasmin. Anatomic changes in the outer segments were seen in 7 of 17 patients reported in a series by Singh et al. […] A systematic meta-analysis of 5 randomized controlled trials was published in 2020 and involved 1067 participants. This analysis showed that ocriplasmin treatment did result in better vision than controls at 6 months with a lowered rate of vitrectomy and increased macular hole closure. […] Patients treated with ocriplasmin did have higher short term visual impairment which may not have impacted visual acuity results such as due to floaters, photopsia, eye pain and dyschromatopsia.

• #28 Macular Hole Medication: Ophthalmic, Other

  https://emedicine.medscape.com/article/1224320-medication

  The first protease to treat vitreomacular adhesions associated with macular hole was approved by the FDA in October 2012. Nonsurgical closure of the macular hole was shown in 40.6% of patients treated with an intravitreal injection of ocriplasmin compared with 10.6% who received placebo. […] However, there is evidence of potential retinal toxicity associated with the use of ocriplasmin. Anatomic changes in the outer segments were seen in 7 of 17 patients reported in a series by Singh et al. […] A systematic meta-analysis of 5 randomized controlled trials was published in 2020 and involved 1067 participants. This analysis showed that ocriplasmin treatment did result in better vision than controls at 6 months with a lowered rate of vitrectomy and increased macular hole closure. […] Patients treated with ocriplasmin did have higher short term visual impairment which may not have impacted visual acuity results such as due to floaters, photopsia, eye pain and dyschromatopsia.

• #29 Macular Hole Medication: Ophthalmic, Other

  https://emedicine.medscape.com/article/1224320-medication

  Protease enzymes provide a nonsurgical treatment method for vitreomacular adhesion. […] Elicits proteolytic activity against protein components within the vitreous body and vitreoretinal interface (eg, laminin, fibronectin, collagen), thereby dissolving the protein matrix responsible for vitreomacular adhesion. […] Ocriplasmin for treatment of vitreomacular traction and macular hole: A systematic literature review and individual participant data meta-analysis of randomized, controlled, double-masked trials.

• #30 Macular Hole: Symptoms, Causes, & Treatment

  https://my.clevelandclinic.org/health/diseases/14208-macular-hole

  A macular hole is a full-thickness defect in your macula, part of your retina. Surgery to treat a macular hole has high success rates if the hole is small. […] The most common treatment for macular holes is a procedure called a vitrectomy. A vitrectomy is a surgery during which a retina specialist removes the vitreous gel of your eye. Your surgeon, an ophthalmologist trained in retina surgery, may also remove any bits of tissue (membranes) that may be putting tension on your macula. […] Your surgeon will put a sterile gas into your eye to keep pressure on the hole until it heals. You may have to stay in a facedown position for one to seven days to keep the bubble in place so the hole will close. […] If you have a small hole, your retina specialist may suggest watching and waiting rather than treating it. Sometimes an early-stage macular hole will close on its own. […] The success rate for vitrectomy surgeries is over 90%. The surgery is most successful when the hole is smaller and more recent. You may regain most or some of your lost vision. […] If you get treatment sooner, or if the hole is small, your prognosis (outlook) is good.

• #31 Macular Hole

  https://www.asrs.org/patients/retinal-diseases/4/macular-hole

  Vitrectomy is the most common treatment for macular holes. In this surgical procedure, the vitreous gel is removed to stop it from pulling on the retina, and most commonly a gas bubble is placed in the eye to gently hold the edges of the macular hole closed until it heals. […] Another potential treatment for some patients with macular holes is the injection of ocriplasmin (Jetrea) into the vitreous. This drug helps to relieve vitreous traction on some macular holes. […] In cases where the macular hole is very small and does not have a large impact on your vision, your doctor may not recommend any treatment at all. He or she may simply observe and track the macular holes progression or natural healing. In this case, it would be important to have regular follow-up eye examinations as determined by your eye doctor to catch and treat any problems early.

• #32 Macular Hole | National Eye Institute

  https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-hole

  Treatment: Close observation for small holes, surgery for most cases […] If a macular hole is affecting your vision, you’ll probably need a type of surgery called vitrectomy to fix the hole and prevent permanent vision loss. […] During a vitrectomy, the doctor removes the vitreous and some tissues on the surface of the macula and injects a gas bubble into your eye. […] Treatment works best when doctors catch macular holes early, so it’s important to talk to your eye doctor right away if you notice symptoms of a macular hole.

• #33 Macular Hole – EyeWiki

  https://eyewiki.org/Macular_Hole

  Macular Hole ICD-9 code: 362.54 […] The clinical stage and duration of the MH is the most important issue in the management of this entity. […] In general, most Stage 1 MH can be followed conservatively given approximately 50% chance of spontaneous closure. However, if the patient has symptomatic VMT or even a full-thickness macular hole with associated VMT, some may consider one of the following treatment options: Intravitreal ocriplasmin. Ocriplasmin is a 27 kilodalton serine protease that essentially performs pharmacolytic vitreolysis, separating the hyaloid from the underlying retina. […] Surgery involves a pars plana vitrectomy procedure with tamponade. This can be done with or without peeling of the internal limiting membrane. […] Visual acuity improvement does not occur immediately in some patients. Visual improvement seems to be dependent on preoperative characteristics, duration of the MH, as well as other factors.

• #34 Study finds medicated eye drops may help close macular holes without surgery – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/research-and-discoveries-articles/2021/january/medication-closes-small-macular-holes

  Medicated drops may help close small macular holes over a two- to eight-week period, allowing some people to avoid surgery to fix the vision problem, a new study suggests. […] For certain patients, medicated drops may heal their macular hole by decreasing inflammation and increasing fluid absorption in the retina, said ophthalmologist and retinal surgeon Dimitra Skondra, MD, PhD, senior author of the study. […] As an alternative to surgery, the researchers prescribed a daily three-drug regimen medications that are FDA-approved and routinely used for other eye conditions consisting of prednisolone or difluprednate, ketorolac or bromfenac and brinzolamide or dorzolamide. […] Using this topical medicated treatment, 12 of the 14 patients had holes that closed within two to eight weeks two to four times faster than spontaneous closure rates of macular holes.

• #35 Closure of Macular Holes With Topical Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10037758/

  To report the results of a nonsurgical approach to repair macular holes (MHs). […] 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. […] Recent case reports and small case series have reported success closing MHs with topical therapy. […] Numerous authors have described how topical steroids are beneficial in reducing macular edema, closing MHs, and improving visual acuity. […] In our consecutive series of patients with an MH, topical therapy for early small holes achieved a success rate greater than 50%. […] 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. […] Overall, our results indicate that initial topical therapy for MHs is preferable for the patient and the physician. This strategy carries little risk, and more than 50% of the patients avoided surgery with the attendant possible adverse events.

• #36 Study finds medicated eye drops may help close macular holes without surgery – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/research-and-discoveries-articles/2021/january/medication-closes-small-macular-holes

  Medicated drops may help close small macular holes over a two- to eight-week period, allowing some people to avoid surgery to fix the vision problem, a new study suggests. […] For certain patients, medicated drops may heal their macular hole by decreasing inflammation and increasing fluid absorption in the retina, said ophthalmologist and retinal surgeon Dimitra Skondra, MD, PhD, senior author of the study. […] As an alternative to surgery, the researchers prescribed a daily three-drug regimen medications that are FDA-approved and routinely used for other eye conditions consisting of prednisolone or difluprednate, ketorolac or bromfenac and brinzolamide or dorzolamide. […] Using this topical medicated treatment, 12 of the 14 patients had holes that closed within two to eight weeks two to four times faster than spontaneous closure rates of macular holes.

• #37 Closure of Macular Holes With Topical Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10037758/

  To report the results of a nonsurgical approach to repair macular holes (MHs). […] 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. […] Recent case reports and small case series have reported success closing MHs with topical therapy. […] Numerous authors have described how topical steroids are beneficial in reducing macular edema, closing MHs, and improving visual acuity. […] In our consecutive series of patients with an MH, topical therapy for early small holes achieved a success rate greater than 50%. […] 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. […] Overall, our results indicate that initial topical therapy for MHs is preferable for the patient and the physician. This strategy carries little risk, and more than 50% of the patients avoided surgery with the attendant possible adverse events.

• #38 Medical Management of Full-Thickness Macular Holes – Retina Today

  https://retinatoday.com/articles/2022-apr/medical-management-of-full-thickness-macular-holes

  The studies also suggest that the best candidates for the nonsurgical approach include those with small FTMHs with cystoid degeneration and no significant tractional component. […] While further studies are necessary, topical therapy may be particularly worthwhile for treatment of small FTMHs with CME and no significant tractional component in patients who are unable or reluctant to undergo surgery, or in patients for whom surgery may be delayed due to the COVID-19 pandemic or other reasons.

• #39 Macular hole

  https://www.nhs.uk/conditions/macular-hole/

  Macular hole surgery is a form of keyhole surgery performed under a microscope. […] The eye is then filled with a temporary gas bubble, which presses the hole flat onto the back of the eye to help it seal. […] With the gas in place, the vision in your eye will be very poor a bit like having your eye open under water. […] It generally takes a few months for the gas to be absorbed and vision to improve. […] If you need a general anaesthetic while the gas is still in your eye, it’s vital you tell the anaesthetist so they can avoid certain anaesthetic agents that can cause expansion of the bubble. […] The hole may fail to close, but this normally won’t have made your vision any worse, and it’s usually possible to repeat the surgery. […] You’ll almost certainly get a cataract after the surgery, usually within a year if you’ve not already had a cataract operation. […] There’s also a risk of retinal detachment, where the retina detaches from the back of the eye. […] An increase in pressure within the eye is quite common in the days after macular hole surgery, usually due to the expanding gas bubble.

• #40 Macular Hole | Eye Disorders | Ophthalmology | Area of Care | SUNY Downstate

  https://www.downstate.edu/patient-care/find-treatment/areas-of-care/ophthalmology/eye-disorders/macular-hole.html

  Maintaining a face-down position is crucial to the success of the surgery. Because this position can be difficult for many people, it is important to discuss this with your doctor before surgery. […] What are the risks of surgery? […] The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated. […] How successful is this surgery? […] Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.

• #41 Macular Hole | Eye Disorders | Ophthalmology | Area of Care | SUNY Downstate

  https://www.downstate.edu/patient-care/find-treatment/areas-of-care/ophthalmology/eye-disorders/macular-hole.html

  Maintaining a face-down position is crucial to the success of the surgery. Because this position can be difficult for many people, it is important to discuss this with your doctor before surgery. […] What are the risks of surgery? […] The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated. […] How successful is this surgery? […] Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.

• #42 Macular Hole Treatment & Management: Medical Care, Surgical Care, Complications

  https://emedicine.medscape.com/article/1224320-treatment

  The critical step appears to be the removal of the perimacular traction. […] The removal of ILM is considered to be a contributing factor in the success of macular hole surgeries. […] The use of pharmacologic adjuncts, such as a transforming growth factor-beta (TGF-beta) and autologous serum, to facilitate hole closure has not been proven to have any added benefit as compared with controls such that their use has not gained much popularity. […] Wu et al described the use of an autologous retinal transplant (ART) to close a refractory macular hole in 2018. Subsequent studies have demonstrated the efficacy of this technique to close refractory macular holes or very large primary idiopathic macular holes. […] Surgical complications include retinal detachments, iatrogenic retinal tears, enlargement of the hole, macular light toxicity, postoperative pressure elevation, and cataractogenesis. […] Because complications, such as cataracts and retinal detachment, can follow treatment for macular holes, regular examinations are necessary.

• #43 Macular hole

  https://www.nhs.uk/conditions/macular-hole/

  Macular hole surgery is a form of keyhole surgery performed under a microscope. […] The eye is then filled with a temporary gas bubble, which presses the hole flat onto the back of the eye to help it seal. […] With the gas in place, the vision in your eye will be very poor a bit like having your eye open under water. […] It generally takes a few months for the gas to be absorbed and vision to improve. […] If you need a general anaesthetic while the gas is still in your eye, it’s vital you tell the anaesthetist so they can avoid certain anaesthetic agents that can cause expansion of the bubble. […] The hole may fail to close, but this normally won’t have made your vision any worse, and it’s usually possible to repeat the surgery. […] You’ll almost certainly get a cataract after the surgery, usually within a year if you’ve not already had a cataract operation. […] There’s also a risk of retinal detachment, where the retina detaches from the back of the eye. […] An increase in pressure within the eye is quite common in the days after macular hole surgery, usually due to the expanding gas bubble.

• #44 What is a macular hole?

  https://www.wolfeeyeclinic.com/medical-services/retina-disease/macular-hole

  If you elect not to repair the hole, it will usually enlarge, making the blind spot bigger over time. The larger the hole becomes, the less likely a hole can be closed with surgery. […] Retina surgeons at Wolfe Eye Clinic and our respective retina staff members are here to help answer any questions you may have regarding macular holes and other retina conditions.

• #45 Macular hole

  https://www.nhs.uk/conditions/macular-hole/

  Macular hole surgery is a form of keyhole surgery performed under a microscope. […] The eye is then filled with a temporary gas bubble, which presses the hole flat onto the back of the eye to help it seal. […] With the gas in place, the vision in your eye will be very poor a bit like having your eye open under water. […] It generally takes a few months for the gas to be absorbed and vision to improve. […] If you need a general anaesthetic while the gas is still in your eye, it’s vital you tell the anaesthetist so they can avoid certain anaesthetic agents that can cause expansion of the bubble. […] The hole may fail to close, but this normally won’t have made your vision any worse, and it’s usually possible to repeat the surgery. […] You’ll almost certainly get a cataract after the surgery, usually within a year if you’ve not already had a cataract operation. […] There’s also a risk of retinal detachment, where the retina detaches from the back of the eye. […] An increase in pressure within the eye is quite common in the days after macular hole surgery, usually due to the expanding gas bubble.

• #46 Diagnosis and Treatment – Moorfields Private

  https://moorfields.nhs.uk/private/eye-conditions-and-treatments/macular-hole/diagnosis-and-treatment

  If we put a gas or air bubble in your eye you must not fly for the periods of time specified below. This is because the gas or air bubble will expand in size and can lead to raised pressure inside your eye, leading to visual loss. […] Your eye will take between two and six weeks to heal, but your vision might continue to improve for several months. […] If we put gas or silicone oil in your eye, we usually ask you to posture for up to seven days. This means lying or sitting in a position that keeps your face down (so that the bubble floats up and presses the retina into position while it is healing).

• #47 Hole in Retina: Symptoms, Causes, Treatment

  https://www.healthline.com/health/eye-health/hole-in-retina

  This injection is painless youll be given a local anesthetic and eye drops beforehand. […] There are two other treatments for peripheral retinal holes that arent in the macula: laser photocoagulation, which burns the edges of the hole in order to create scar tissue that seals it, and cryopexy, which uses a probe over the top of your eye to freeze the tissue surrounding the hole and attach it to the inside of the eye. […] If you have a vitrectomy, youll wake up with a protective shield taped over your eye. […] If you received the injection, youll usually be monitored for up to a week afterward to check for infections or complications. […] Without regular eye exams and treatment where needed, the hole will likely get worse. […] But a hole in the retina wont affect peripheral vision, so a person wont become blind.

• #48 Macular hole – Macular Society

  https://www.macularsociety.org/macular-disease/macular-conditions/macular-hole/

  A vitrectomy is surgery that removes the gel from the eye under local anaesthetic. A gas bubble is then put into the eye to block the hole allowing the retina to become flat again, and the hole closes. […] Following surgery, the eye may be sensitive, swollen and red. You will be prescribed eye drops to prevent infection and reduce inflammation. […] Posturing is a form of recovery that involves keeping the head face-down for up to two weeks after surgery to ensure the gas or oil puts pressure in the right place to help close the macular hole. […] Vision will improve gradually over several months. An average improvement is being able to read two or three more lines on the eye chart. Success depends upon the age of the hole. […] The treatment of macular holes younger than 6 months has a success rate of over 90%. For holes older than 12 months the success rate is less. If the hole does not close after the first operation, further operations may be done but the chances of visual recovery in these situations are often not very high.

• #49 Macular Hole: Symptoms, Causes, & Treatment

  https://my.clevelandclinic.org/health/diseases/14208-macular-hole

  A macular hole is a full-thickness defect in your macula, part of your retina. Surgery to treat a macular hole has high success rates if the hole is small. […] The most common treatment for macular holes is a procedure called a vitrectomy. A vitrectomy is a surgery during which a retina specialist removes the vitreous gel of your eye. Your surgeon, an ophthalmologist trained in retina surgery, may also remove any bits of tissue (membranes) that may be putting tension on your macula. […] Your surgeon will put a sterile gas into your eye to keep pressure on the hole until it heals. You may have to stay in a facedown position for one to seven days to keep the bubble in place so the hole will close. […] If you have a small hole, your retina specialist may suggest watching and waiting rather than treating it. Sometimes an early-stage macular hole will close on its own. […] The success rate for vitrectomy surgeries is over 90%. The surgery is most successful when the hole is smaller and more recent. You may regain most or some of your lost vision. […] If you get treatment sooner, or if the hole is small, your prognosis (outlook) is good.

• #50 Macular Hole Surgery – Vitreous Retina Macula Consultants of New York

  https://www.vrmny.com/conditions/macular-hole/

  With the retinal tissue in its proper position and immobilized, we hope the hole will close. The amazing thing is that it often does close. Small holes close a little more than 90% of the time after 1 operation. Once the hole size exceeds 400 microns in diameter about the equivalent thickness of 4 pieces of paper stacked together the proportion of successful cases drops off dramatically. […] Generally the patient uses eye drops for 2 to 3 weeks after the macular hole repair surgery. Complications of the surgery include an approximately 1% chance of causing a retinal tear or detachment that would require additional surgery to repair. […] Most patients with macular hole surgery improve by about 3 lines of visual acuity.

• #51 AAO Idiopathic Macular Hole Guideline Summary

  https://www.guidelinecentral.com/guideline/10150/

  Idiopathic macular holes are more common in females than in males and usually occur after age 55. […] Patients with vitreous traction, good vision, and no macular hole (stage 1-A or 1-B) should be observed without treatment, because they often remain stable or even improve. Currently, there is no evidence that treatment improves their prognosis. […] Most patients with stages 2, 3 and 4 macular holes will have a poor prognosis without treatment. The visual prognosis is good following successful macular hole closure. The benefits of treatment designed to achieve macular hole closure should be discussed. […] Early detection of a macular hole is associated with a higher closure rate after vitrectomy and better postoperative visual acuity. […] Studies report that approximately 90% of recent-onset (less than 6 months duration) macular holes that are 400 m or smaller in diameter can be closed with vitrectomy surgery.

• #52 Macular Hole – EyeWiki

  https://eyewiki.org/Macular_Hole

  The complications are similar to all eyes undergoing pars plana vitrectomy. In particular, these patients are at a higher risk for retinal tear and detachment. […] The visual outcomes following pars plana vitrectomy are very favorable. In general, better the preoperative visual acuity results in better postoperative visual acuity. However, eyes with worse preoperative visual acuity often experience the greatest absolute postoperative improvement.

• #53 AAO Idiopathic Macular Hole Guideline Summary

  https://www.guidelinecentral.com/guideline/10150/

  Careful removal of the internal limiting membrane (ILM) during vitrectomy surgery increases the macular hole closure rate without adversely affecting visual acuity. […] Cataract development or progression is a frequent side effect of vitrectomy surgery to repair macular holes. This risk should be discussed with patients preoperatively, and postoperative monitoring is advised.

• #54 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  Peeling the internal limiting membrane and epiretinal membranes has become the standard technique to address vitreomacular interface diseases. […] Human amniotic membrane transplant and autologous retinal transplant are recent approaches to the treatment of refractory macular holes. […] Retinal expansion is a valuable technique for macular holes, in which subretinal injection of balanced salt solution creates a macular detachment. […] To determine the appropriate treatment approach for FTMHs, we first measure the hole size and the baseline visual acuity. Based on these criteria, clinicians can decide to monitor, treat medically, or proceed to the OR. A surgical approach to FTMHs has three main objectives: lower the resistance to facilitate the closure with the maculorexis; decrease the size by drying with fluid-air exchange; and provide a gas tamponade (SF6).

• #55 Tips for Managing Complicated Macular Holes | Retinal Physician

  https://retinalphysician.com/issues/2024/julyaugust/tips-for-managing-complicated-macular-holes/

  Recent advancements in surgical techniques, such as autologous retinal transplant (ART) and amniotic membrane graft (AMG), have improved outcomes for treating complicated macular holes, particularly those that are refractory to initial surgery. […] Scaffold-based approaches like ART and AMG, along with expansion-based techniques involving subretinal blebs, offer tailored solutions to achieve better anatomic and functional outcomes in eyes with large or complicated macular holes. […] The retracting-door internal limiting membrane (ILM) flap technique helps preserve ILM for potential future use and reduces the risk of flap displacement, making it a useful method for first-time macular hole surgeries. […] An area of focus over the past decade has been to improve surgical techniques in eyes with complicated macular holes wherein prognosis for successful macular hole closure and improved visual acuity is less favorable.

• #56 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  At the 2019 Retina World Congress, Tamer H. Mahmoud, MD, PhD, presented on autologous retinal transplantation (ART) for macular holes, adding to our growing armamentarium. Human amniotic membrane transplant (hAM) is yet another recent technique that has made the treatment of recurrent and refractory FTMHs possible. […] A large retrospective case series of 130 patients undergoing ART for the repair of primary and refractory macular holes showed good anatomic and functional outcomes. […] Several alternative surgical options may prove useful for certain refractory macular holes, such as various ILM flap techniques, retinal expansion, lens capsule transplantation, blood products, and macular buckling. […] The retinal expansion technique is another valuable alternative to macular hole closure. Subretinal injection of balanced salt solution creates a macular detachment, which may lead to hole closure. […] Alezzandrini et al published a study to compare the functional and anatomic outcomes at 24 months of eyes with a primary FTMH that failed to close after surgery and were treated with either an ART of ILM (ART-ILM) or the retinal expansion technique.

• #57 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  At the 2019 Retina World Congress, Tamer H. Mahmoud, MD, PhD, presented on autologous retinal transplantation (ART) for macular holes, adding to our growing armamentarium. Human amniotic membrane transplant (hAM) is yet another recent technique that has made the treatment of recurrent and refractory FTMHs possible. […] A large retrospective case series of 130 patients undergoing ART for the repair of primary and refractory macular holes showed good anatomic and functional outcomes. […] Several alternative surgical options may prove useful for certain refractory macular holes, such as various ILM flap techniques, retinal expansion, lens capsule transplantation, blood products, and macular buckling. […] The retinal expansion technique is another valuable alternative to macular hole closure. Subretinal injection of balanced salt solution creates a macular detachment, which may lead to hole closure. […] Alezzandrini et al published a study to compare the functional and anatomic outcomes at 24 months of eyes with a primary FTMH that failed to close after surgery and were treated with either an ART of ILM (ART-ILM) or the retinal expansion technique.

• #58 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  At the 2019 Retina World Congress, Tamer H. Mahmoud, MD, PhD, presented on autologous retinal transplantation (ART) for macular holes, adding to our growing armamentarium. Human amniotic membrane transplant (hAM) is yet another recent technique that has made the treatment of recurrent and refractory FTMHs possible. […] A large retrospective case series of 130 patients undergoing ART for the repair of primary and refractory macular holes showed good anatomic and functional outcomes. […] Several alternative surgical options may prove useful for certain refractory macular holes, such as various ILM flap techniques, retinal expansion, lens capsule transplantation, blood products, and macular buckling. […] The retinal expansion technique is another valuable alternative to macular hole closure. Subretinal injection of balanced salt solution creates a macular detachment, which may lead to hole closure. […] Alezzandrini et al published a study to compare the functional and anatomic outcomes at 24 months of eyes with a primary FTMH that failed to close after surgery and were treated with either an ART of ILM (ART-ILM) or the retinal expansion technique.

• #59 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  At the 2019 Retina World Congress, Tamer H. Mahmoud, MD, PhD, presented on autologous retinal transplantation (ART) for macular holes, adding to our growing armamentarium. Human amniotic membrane transplant (hAM) is yet another recent technique that has made the treatment of recurrent and refractory FTMHs possible. […] A large retrospective case series of 130 patients undergoing ART for the repair of primary and refractory macular holes showed good anatomic and functional outcomes. […] Several alternative surgical options may prove useful for certain refractory macular holes, such as various ILM flap techniques, retinal expansion, lens capsule transplantation, blood products, and macular buckling. […] The retinal expansion technique is another valuable alternative to macular hole closure. Subretinal injection of balanced salt solution creates a macular detachment, which may lead to hole closure. […] Alezzandrini et al published a study to compare the functional and anatomic outcomes at 24 months of eyes with a primary FTMH that failed to close after surgery and were treated with either an ART of ILM (ART-ILM) or the retinal expansion technique.

• #60 Topical drop treatment for full-thickness macular hole closure

  https://www.modernretina.com/view/topical-drop-treatment-for-full-thickness-macular-hole-closure

  A newly reported study, led by first author Jessie Wang, MD, found that topical therapy resulted in closure of full-thickness macular holes in more than a third of patients; higher efficacy was seen in patients with smaller holes and in those without vitreomacular traction (VMT). […] Wang and colleagues reported, Eighteen of 49 eyes (36.7%) achieved closure on topical therapy, of which 13 eyes were idiopathic. […] In addition to the overall macular hole closure rate of 36.7% achieved with topical therapy, higher efficacy was achieved in patients with smaller holes and no VMT. They also noted that the rates of macular hole narrowing and reduction in the central foveal thickness were predictors of the efficacy of drop therapy.

• #61 Macular Hole Treatment & Management: Medical Care, Surgical Care, Complications

  https://emedicine.medscape.com/article/1224320-treatment

  The critical step appears to be the removal of the perimacular traction. […] The removal of ILM is considered to be a contributing factor in the success of macular hole surgeries. […] The use of pharmacologic adjuncts, such as a transforming growth factor-beta (TGF-beta) and autologous serum, to facilitate hole closure has not been proven to have any added benefit as compared with controls such that their use has not gained much popularity. […] Wu et al described the use of an autologous retinal transplant (ART) to close a refractory macular hole in 2018. Subsequent studies have demonstrated the efficacy of this technique to close refractory macular holes or very large primary idiopathic macular holes. […] Surgical complications include retinal detachments, iatrogenic retinal tears, enlargement of the hole, macular light toxicity, postoperative pressure elevation, and cataractogenesis. […] Because complications, such as cataracts and retinal detachment, can follow treatment for macular holes, regular examinations are necessary.

• #62 Macular hole repair does not require face-down positioning – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/ophthalmology/news/macular-hole-repair-does-not-require-face-down-positioning/mac-20430610

  Macular hole repair does not require face-down positioning. A retrospective study of 68 eyes (65 patients) indicates that macular hole surgery with broad internal limiting membrane (ILM) peeling, 20% sulfur hexafluoride (SF6) gas and no face-down positioning is highly effective in the surgical treatment of idiopathic macular holes. The method also eliminates the morbidity associated with postoperative face-down positioning. „Closure methods that eliminate the need for face-down positioning and do not compromise closure rates would reduce patient morbidity significantly, improve patient satisfaction and represent a significant advancement in surgery for macular holes,” says Dr. Iezzi. „Although this retrospective study has limitations, our data suggest that by using broad ILM peeling, 20% SF6 gas and no face-down positioning, macular hole closure rates are comparable with or better than those of other closure methods.”

• #63 Macular hole repair does not require face-down positioning – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/ophthalmology/news/macular-hole-repair-does-not-require-face-down-positioning/mac-20430610

  „Visual acuity improved in all patients who achieved successful anatomical closure,” says Dr. Iezzi, „which was approximately 95%.” This study shows that no-face-down macular hole repair is noninferior to face-down procedures, and vision can improve even when the macular hole has been present for many years.

• #64 Macular hole repair does not require face-down positioning – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/ophthalmology/news/macular-hole-repair-does-not-require-face-down-positioning/mac-20430610

  Macular hole repair does not require face-down positioning. A retrospective study of 68 eyes (65 patients) indicates that macular hole surgery with broad internal limiting membrane (ILM) peeling, 20% sulfur hexafluoride (SF6) gas and no face-down positioning is highly effective in the surgical treatment of idiopathic macular holes. The method also eliminates the morbidity associated with postoperative face-down positioning. „Closure methods that eliminate the need for face-down positioning and do not compromise closure rates would reduce patient morbidity significantly, improve patient satisfaction and represent a significant advancement in surgery for macular holes,” says Dr. Iezzi. „Although this retrospective study has limitations, our data suggest that by using broad ILM peeling, 20% SF6 gas and no face-down positioning, macular hole closure rates are comparable with or better than those of other closure methods.”

• #65 Macular Hole Surgery in Colorado | Denver Metro Area

  https://www.retinacolorado.com/retinal-care/macular-hole

  If you have a larger and chronic macular hole, highly myopic eyes with posterior pole staphyloma or a traumatic macular hole, your surgeon may recommend internal limiting membrane (ILM) peeling to increase the chance of success to regain vision. ILM peeling may reduce the duration of face-down positioning required for macular hole closure. With ILM peeling, five or fewer days of face-down positioning may be adequate to effect hole closure. Peeling the ILM eliminates all tangential traction around the edges of the hole, the process believed to contribute to macular hole formation. It also ensures removal of any hyaloid remnants or epiretinal membranes that could otherwise be missed. […] Pneumatic vitreolysis is when a gas bubble is injected into the eye in clinic then when the patient bends forward over and over the bubble rolls across the back of the eye attempting to break the connection between the gel and the retina, sometimes allowing the hole to close once that connection is broken. Pars plana vitrectomy is the most successful way of closing the hole but requires going to the operating room for surgery. Surgically the gel is removed from the eye, a layer called the internal limiting membrane of the retina is removed, and then the eye is filled with a gas bubble. That gas bubble helps push the hole closed. Gas bubbles dissolve away on their own over a period of 3 to 8 weeks. Sometimes your surgeon will ask you to maintain a face-down position to maximize the changes of surgical success.

• #66 Macular Hole Chicago | Macular Hole Treatment | Retina Specialist

  https://www.retinacenterchicago.com/macular-hole/

  A macular hole is a small break or tear in the macula, the central part of the retina responsible for sharp, detailed vision. […] The most common treatment for a macular hole is vitrectomy, where the vitreous gel is removed and replaced with a gas bubble. This bubble gently presses against the macula, allowing the hole to close and the retina to heal. […] Our practice is at the forefront of offering surgical options that require minimal face-down positioning after surgery. This innovation provides greater comfort and convenience for our patients, reducing the challenges traditionally associated with macular hole recovery. […] Our team is dedicated to providing the latest advancements in macular hole treatment, ensuring the best possible outcomes with improved post-surgical comfort.

• #67 Macular Hole | National Eye Institute

  https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-hole

  Treatment: Close observation for small holes, surgery for most cases […] If a macular hole is affecting your vision, you’ll probably need a type of surgery called vitrectomy to fix the hole and prevent permanent vision loss. […] During a vitrectomy, the doctor removes the vitreous and some tissues on the surface of the macula and injects a gas bubble into your eye. […] Treatment works best when doctors catch macular holes early, so it’s important to talk to your eye doctor right away if you notice symptoms of a macular hole.

• #68 Macular Hole – Sapphire Eye Care

  https://sapphire-eyecare.co.uk/treatments/macular-hole/answerpack/macular-hole/is-my-macular-hole-too-advanced-for-treatment

  Vitrectomy surgery involves removing the vitreous gel to prevent it from pulling on the retina and then filling the eye with a gas bubble that gently allows the edges of the macular hole to come together, promoting natural healing and closure of the hole. […] It is important to seek treatment promptly if these symptoms arise, as early intervention can lead to better surgical outcomes and may prevent further vision loss. […] Recovery from macular hole surgery usually requires patients to not to lie flat on their backs for the first two weeks to allow the gas bubble to exert pressure on the macula or there may sometimes be advantages to posturing face-down for a period of time after surgery. […] Macular hole surgery at Sapphire Eye Care is performed using state-of-the-art equipment to conduct a vitrectomy. Our surgeons carefully remove the vitreous gel and a gas bubble is inserted into the eye to promote the holes closure. […] Macular hole surgery has a high success rate, especially when performed on holes that have not been present for an extended period. Most patients at Sapphire Eye Care experience significant improvement in their vision.

• #69 Macular Hole Specialist – Midtown New York, NY & Brooklyn, NY: New York Retina and Macula Institute: Medical Retina Specialist

  https://www.nyretinainstitute.com/services/macular-hole

  Nearsighted women over the age of 60 are at risk for developing a macular hole in their retina, and men can suffer from this condition, too. […] As a board-certified ophthalmologist and retinal surgery specialist, Aryeh L. Pollack, MD, expertly diagnoses and treats macular holes at his New York City practice, New York Retina and Macula Institute. […] The most common treatment for macular holes is a surgical procedure called a vitrectomy. During this type of surgery at New York Retina and Macula Institute, Dr. Pollack, a leading retinal surgeon, removes the vitreous from your eye to prevent it from pulling at the retina. He may place a small gas bubble in your eye to gently hold the edges of the macular hole closed as it heals after surgery. […] Vitrectomy has a success rate of over 90%, allowing most people to regain some or all of their lost vision. […] If your macular hole is tiny enough that its not significantly impacting your vision, you may not need treatment right away. Instead, Dr. Pollack monitors the holes progression so he can detect and treat any changes as soon as they occur.

• #70 Macular Hole: Symptoms, Causes and Treatments | Group of Top Eye Hospitals In India | Centre For Sight

  https://www.centreforsight.net/blog/macular-hole

  Nearly 8 in every 10,000 individuals worldwide will face a perplexing and often distressing vision condition known as a macular hole. […] The primary treatment for a macular (retinal) hole is a macular hole surgery, also known as vitrectomy. During a vitrectomy, the surgeon removes the vitreous gel that is pulling on the macula and replaces it with a bubble of gas or air. This bubble acts as a temporary internal bandage that holds the edges of the macular hole in place as it heals. […] In macular hole treatment, patients typically need to maintain a specific head positioning, often face-down, for several days to a week after surgery to ensure the bubble effectively presses against the hole. […] Recognizing the symptoms early and seeking prompt medical attention can lead to effective treatment and improved outcomes. Advances in surgical techniques continue to enhance the success rates of treating macular holes, offering hope to those affected by this condition.

• #71 Macular Hole | Eye Disorders | Ophthalmology | Area of Care | SUNY Downstate

  https://www.downstate.edu/patient-care/find-treatment/areas-of-care/ophthalmology/eye-disorders/macular-hole.html

  Maintaining a face-down position is crucial to the success of the surgery. Because this position can be difficult for many people, it is important to discuss this with your doctor before surgery. […] What are the risks of surgery? […] The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated. […] How successful is this surgery? […] Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.

• #72 Diagnosis and Treatment – Moorfields Private

  https://moorfields.nhs.uk/private/eye-conditions-and-treatments/macular-hole/diagnosis-and-treatment

  If we put a gas or air bubble in your eye you must not fly for the periods of time specified below. This is because the gas or air bubble will expand in size and can lead to raised pressure inside your eye, leading to visual loss. […] Your eye will take between two and six weeks to heal, but your vision might continue to improve for several months. […] If we put gas or silicone oil in your eye, we usually ask you to posture for up to seven days. This means lying or sitting in a position that keeps your face down (so that the bubble floats up and presses the retina into position while it is healing).

• #73

  https://www.aao.org/eye-health/diseases/macular-hole-treatment/?amp=1

  Surgery called vitrectomy is the best way to treat a macular hole. Your ophthalmologist removes the vitreous that is pulling on your macula. Then he or she puts a gas bubble inside the eye. This bubble helps flatten the macular hole and hold it in place while your eye heals. The gas bubble slowly goes away on its own. […] Your vision will improve as the macular hole closes. It may take several months for the hole to finish healing. How much vision you get back depends on the size of your macular hole. It also depends on how long the hole was there before you had surgery. […] Your ophthalmologist will talk about these risks and how vitrectomy surgery may help you.

• #74 Macular hole – a patient’s guide of causes and treatments

  https://maculacenter.com/eye-disease/macular-hole/

  Vision improvement varies from patient to patient. […] If you cannot remain in a face-down position for the required period after surgery, vision recovery may not be successful. […] If a macular hole exists in one eye, there is a 10-15 percent chance that a macular hole will develop in your other eye over your lifetime.

• #75 Macular Hole Surgery in Colorado | Denver Metro Area

  https://www.retinacolorado.com/retinal-care/macular-hole

  Macular hole repair is one of the most predictably successful surgical procedures for our retina surgeons, with a single operation success rate in excess of 90%. Surgical treatment with pars plana vitrectomy, internal limiting membrane (ILM) peeling, and gas injection is the gold standard for macular hole treatment. Historically, patients needed to assume a face-down position after surgery for many days but those requirements have been reduced or eliminated with modern techniques used by the retina surgeons at Colorado Retina. […] Pars plana vitrectomy is the most common treatment for macular holes. In this surgical procedure, the vitreous gel is removed to stop it from pulling on the retina, and most commonly a gas bubble is placed in the eye to gently hold the edges of the macular hole closed until it heals. The patient may be asked to maintain a face-down position for several days depending on the characteristics of the macular hole. This will allow the bubble to gradually dissolve and be replaced by natural eye fluids. Vitrectomy has a success rate of over 90%, with patients regaining some or most of their lost vision.

• #76 Macular hole | Macular Disease Foundation Australia Macular Disease Foundation Australia

  https://www.mdfoundation.com.au/about-macular-disease/other-macular-conditions/macular-hole/

  Over 90 per cent of holes will close after surgery. […] Macular hole surgery normally helps maintain good vision. Rarely, a second operation may be needed to help close the hole. If surgery is unsuccessful, central vision is usually lost, as it would be if your macular hole remained untreated. […] If posturing is necessary, you’ll need to plan for this before the operation. You’ll most likely need some help after your procedure as well. […] Talk to your ophthalmologist about these and other possible complications.

• #77 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  Peeling the internal limiting membrane and epiretinal membranes has become the standard technique to address vitreomacular interface diseases. […] Human amniotic membrane transplant and autologous retinal transplant are recent approaches to the treatment of refractory macular holes. […] Retinal expansion is a valuable technique for macular holes, in which subretinal injection of balanced salt solution creates a macular detachment. […] To determine the appropriate treatment approach for FTMHs, we first measure the hole size and the baseline visual acuity. Based on these criteria, clinicians can decide to monitor, treat medically, or proceed to the OR. A surgical approach to FTMHs has three main objectives: lower the resistance to facilitate the closure with the maculorexis; decrease the size by drying with fluid-air exchange; and provide a gas tamponade (SF6).

• #78 Macular Surgery: Current and Innovative Techniques – Retina Today

  https://retinatoday.com/articles/2024-jan-feb/macular-surgery-current-and-innovative-techniques

  At the 2019 Retina World Congress, Tamer H. Mahmoud, MD, PhD, presented on autologous retinal transplantation (ART) for macular holes, adding to our growing armamentarium. Human amniotic membrane transplant (hAM) is yet another recent technique that has made the treatment of recurrent and refractory FTMHs possible. […] A large retrospective case series of 130 patients undergoing ART for the repair of primary and refractory macular holes showed good anatomic and functional outcomes. […] Several alternative surgical options may prove useful for certain refractory macular holes, such as various ILM flap techniques, retinal expansion, lens capsule transplantation, blood products, and macular buckling. […] The retinal expansion technique is another valuable alternative to macular hole closure. Subretinal injection of balanced salt solution creates a macular detachment, which may lead to hole closure. […] Alezzandrini et al published a study to compare the functional and anatomic outcomes at 24 months of eyes with a primary FTMH that failed to close after surgery and were treated with either an ART of ILM (ART-ILM) or the retinal expansion technique.

• #79 Closure of Macular Holes With Topical Therapy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10037758/

  To report the results of a nonsurgical approach to repair macular holes (MHs). […] 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. […] Recent case reports and small case series have reported success closing MHs with topical therapy. […] Numerous authors have described how topical steroids are beneficial in reducing macular edema, closing MHs, and improving visual acuity. […] In our consecutive series of patients with an MH, topical therapy for early small holes achieved a success rate greater than 50%. […] 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. […] Overall, our results indicate that initial topical therapy for MHs is preferable for the patient and the physician. This strategy carries little risk, and more than 50% of the patients avoided surgery with the attendant possible adverse events.

• #80 Macular Hole | Eye Disorders | Ophthalmology | Area of Care | SUNY Downstate

  https://www.downstate.edu/patient-care/find-treatment/areas-of-care/ophthalmology/eye-disorders/macular-hole.html

  Maintaining a face-down position is crucial to the success of the surgery. Because this position can be difficult for many people, it is important to discuss this with your doctor before surgery. […] What are the risks of surgery? […] The most common risk following macular hole surgery is an increase in the rate of cataract development. In most patients, a cataract can progress rapidly, and often becomes severe enough to require removal. Other less common complications include infection and retinal detachment either during surgery or afterward, both of which can be immediately treated. […] How successful is this surgery? […] Vision improvement varies from patient to patient. People that have had a macular hole for less than six months have a better chance of recovering vision than those who have had one for a longer period. Discuss vision recovery with your doctor before your surgery. Vision recovery can continue for as long as three months after surgery.

• #81 Macular Holes: Learn the Risk Factors, Early Symptoms, and Treatment | Cape Fear Retina

  https://www.capefearretina.com/blog/macular-holes-learn-the-risk-factors-early-symptoms-and-treatment/

  Macular holes are relatively rare, and only about 8 out of every 100,000 people will develop one in their lifetime. […] However, everyone needs to learn about them because they can lead to loss of vision if left untreated, and treatment is relatively quick and easy. In addition, the earlier macular holes are treated, the greater the chance of vision recovery in the affected eye. […] Macular holes typically go through three stages of development, and as they progress through the stages, symptoms become more severe. […] If you suspect you may have a macular hole, it is important to get it diagnosed and treated promptly. Macular holes treated within six months of development typically respond much better to treatment than those that have been present longer. Most macular holes are treated with a surgery called a vitrectomy. This is a short, outpatient procedure that can take as little as one hour. After administering a local anesthetic, your ophthalmologist will remove the vitreous gel from your eye and replace it with a special gas. The gas stimulates your macula to heal itself, and your eye gradually replaces it with a new fluid. To aid in the macula healing process, you must lie in bed face down as much as possible until your macula has healed or for at least seven to 10 days after treatment. While this may sound like an inconvenience, it will help ensure your surgery is as successful as possible so you can get your good vision back. […] While relatively uncommon, macular holes can lead to complete central vision loss when left untreated. Reach out to Cape Fear Retina for prompt macular hole diagnosis and treatment if you notice any of the signs or symptoms.

• #82 Tips for Managing Complicated Macular Holes | Retinal Physician

  https://retinalphysician.com/issues/2024/julyaugust/tips-for-managing-complicated-macular-holes/

  For refractory macular holes, surgeons can adopt either a scaffold-based approach or a macular expansion-based approach. […] The ART approach should be avoided in eyes with extensive chorioretinal scarring precluding availability of a good ART harvest site, in eyes with history of proliferative vitreoretinopathy or significant ischemia, and in pediatric eyes. […] A scaffold-based approach facilitates closure of the macular hole by creating an interface to promote glial migration and proliferation to bridge the macular defect. […] For large macular hole-associated retinal detachments, a scaffold-based technique is required, and the AMG or ART techniques can be effective coupled with draining the subretinal fluid using a separate retinotomy. […] In eyes with significant macular ischemia, advanced glaucoma, or optic atrophy causing significant vision impairment that is unlikely to improve following closure of the large macular hole, it is important to recognize the limited visual prognosis. […] Future work may facilitate development of an algorithm to guide a tailored surgical approach to different types of macular holes to achieve better anatomic and functional outcomes, while reducing the number of procedures needed to reach such outcomes.

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