July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Spontaneous closure of idiopathic macular holes, a case series
Author Affiliations & Notes
  • Michael Nee
    VitreoRetinal Consultants, Hingham, Massachusetts, United States
  • Delia Sang
    VitreoRetinal Consultants, Hingham, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Michael Nee, None; Delia Sang, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5021. doi:
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      Michael Nee, Delia Sang; Spontaneous closure of idiopathic macular holes, a case series. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5021.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : To report the incidence of spontaneous macular hole closure in a retrospective series of idiopathic full thickness macular holes, and to evaluate the mechanism of closure and association of size of macular hole and use of topical cortisone/NSAIDS.

Methods : Charts of sequential patients diagnosed with macular hole were reviewed The diagnosis of full thickness spontaneous macular hole was confirmed by chart review and OCT B. Patients were excluded if they were followed for less than six months, or for history of concurrent retinal disease.

Results : A total of 101 idiopathic macular holes were identified in 91 patients from 11/15/15--11/14/18. Thirteen macular holes were excluded with branch or central retinal vein occlusion, diabetic retinopathy, uveitis, or wet ARMD. Six patients were not surgical candidates or refused. Vitrectomy was performed on 76 eyes. Of the remaining 6 patients, the macular holes all closed without surgery; the width of the macular hole ranged 60-273 microns. Of the 6 macular holes, 2 closed spontaneously without topical medications, and 4 closed with cortisone (prednisolone acetate or difluprednate) and NSAIDs (bromfenac, ketorolac or nepafenac). A "bridging" closure was noted on OCT B in 5/ 6 patients, with release of vitreomacular traction in one eye.

Of the 4 holes treated with cortisone / NSAIDSs (avge base diameter 196um), closure occurred at 13 to 84 days, with average duration of 50 days. Three out of four closed with "bridging." The outer retinal cyst resolved by 72 days (55-72 days). Of these patients, 2 closed despite epiretinal membrane, and 1 with cystoid macular edema. Of the 2 that closed spontaneously without topical medications (diameter 107um), one showed bridging at 21 days.

Visual outcome in non-surgical eyes was excellent, ranging from 20/20 to 20/60. The initial vision at time of diagnosis ranged from 20/20-2 to 20/60-2.

Conclusions : Less than 6% of macular holes closed without surgery. Of note, ERM and CME did not prevent closure. Eyes treated with cortisone / NSAIDS did not close more rapidly than those closed without topical medications. Width of macular hole did not appear related to the likelihood of non-surgical macular hole closure.

Larger studies are needed to further investigate treatments, mechanisms and biomarkers in in non-surgical closure of idiopathic macular holes.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.


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