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Patrick Burke, David Parver; The non-surgical closure of full thickness macular holes in patients treated with nonsteroidal anti-inflammatory drugs. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5277.
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© ARVO (1962-2015); The Authors (2016-present)
Full thickness macular hole (FTMH) closure typically requires surgical intervention. Certain patients, however, are poor surgical candidates, and other treatment modalities must be considered. Nonsteroidal anti-inflammatory drugs (NSAID) are increasingly used to treat cystoid macular edema associated with various retinal and uveitic disorders. We performed a retrospective, observational analysis of patients with FTMH testing the hypothesis that topical NSAIDs can facilitate FTMH closure without surgical intervention.
A retrospective analysis of records from 2015-2017 at a community retina practice was performed. Over the 2 year period, patients were identified who had FTMH confirmed by ocular coherence tomography (OCT) and were treated non-surgically with topical NSAIDs alone or in conjunction with steroids. Response to treatment was documented by OCT, and patients were followed for at least 6 months after FTMH diagnosis.
Four patients were identified by the retrospective analysis. The average age of the patients at time of diagnosis was 73 years old (range 65-81 years). Two patients had stage III FTMH and two had stage IV FTMH. All four patients were treated with topical NSAIDs, and one also received an injection of intravitreal steroid. There were no adverse events associated with topical NSAID use. All four patients had FTMH closure documented by OCT. Two of the patients had sustained closure. One patient subsequently had FTMH re-opening necessitating surgical intervention. The fourth patient had re-opening of the FTMH after discontinuation of topical NSAIDs (photo 1), but resumption of the same NSAID again resulted in FTMH closure (photo 2).
NSAIDs are well-studied in the prevention and treatment of cystoid macular edema, though they have not been identified as a common treatment of FTMH. This study describes a retrospective analysis of FTMH closure associated with topical NSAID use. The successful treatment of a FTMH with NSAIDs may implicate an inflammatory response and the cyclo-oxygenase (COX) pathway in the pathogenesis of FTMH. Treatment of this pathway with NSAIDs may decrease macular thickness enough to allow for favorable mechanics and FTMH closure in a subset of patients with cystoid macular edema identified on OCT. Topical NSAIDs may represent a treatment option for patients with FTMH who are unable to undergo surgery.
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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