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Joseph Brooks Alsberge, J. Michael Jumper; Idiopathic Macular Holes Treated with Topical Anti-Inflammatory Agents: A Case Series. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5273.
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It has been postulated that intraretinal fluid accumulation is important in idiopathic macular hole pathogenesis. While macular holes are most commonly treated with vitrectomy surgery, there is speculation that topical therapy that leads to a reduction of intraretinal fluid, such as anti-inflammatory agents, could offer an alternative treatment. The purpose of this study was to retrospectively review outcomes of macular holes treated with topical anti-inflammatory agents.
The case records of three patients with idiopathic full-thickness macular holes who were treated with topical anti-inflammatory agents (corticosteroids and nonsteroidal anti-inflammatory drugs) by a single vitreoretinal specialist between September 2015 and November 2017 were reviewed. The primary outcome measure was the occurrence of hole closure.
Two of the patients were male, and one was female. The median age of the patients was 66 years (mean 63.3, range 56-68 years). The median duration of follow up was 52 weeks (mean 49.7, range 4.4-92.6 weeks). The presence of a full-thickness macular hole was confirmed by spectral domain optical coherence tomography (SD-OCT) in all three patients prior to initiating topical anti-inflammatory therapy. Two of the patients had macular holes that were recurrent following previous successful pars plana vitrectomy and internal limiting membrane peeling, and one of the patients had no history of vitrectomy surgery. The median base diameter and minimum linear diameter of the holes at baseline was 492 microns (mean 483, range 320-637 microns) and 115 microns (mean 112.7, range 105-118 microns), respectively. Case 1 was treated with prednisolone acetate 1%, case 2 with loteprednol etabonate 0.5%, and case 3 with difluprednate 0.05% and bromfenac 0.09%. Median treatment duration was 11 weeks (mean 8.9, range 4.4-11.1 weeks). Macular hole closure occurred in all three patients, as confirmed by SD-OCT. Median time to hole closure was 4.4 weeks (mean 8.1, range 4-16 weeks).
In this series of 3 patients with idiopathic full-thickness macular holes, all developed hole closure following initiation of topical anti-inflammatory therapy. Anti-inflammatory eye drops may be beneficial in the treatment of idiopathic macular holes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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