Medical Treatment of Macular Holes

Abstract

Purpose : Macular holes (MHs) are a common retinal disorder which usually requires surgical treatment with pars plana vitrectomy. Here we present a case series of MHs that had successful closure with topical medical treatment.

Methods : We conducted a retrospective review of the medical records, including optical coherence tomography (OCT) studies, of 11 patients with full-thickness macular holes that responded favorably to medical treatment. Treatment included steroid, non-steroidal anti-inflammatory (NSAID), and carbonic anhydrase inhibitor (CAI) drops.

Results : 8 men and 3 women with an average age of 67.5 years were included in the study. 7 out of 11 eyes had prior vitrectomy (4 for retinal detachment and 3 for previous MH) and non-vitrectomized eyes had vitreous separation from the macula. MHs were diagnosed clinically and confirmed by OCT. The initial OCT study in all cases revealed a full-thickness MH (mean size +/- SD = 184um +/- 80um) with surrounding cystoid hydration. After starting topical medical therapy (steroid + NSAID + CAI), follow-up OCT studies revealed decreases in cystic changes within 2 to 4 weeks and MH closure with visual acuity improvement in 4-8 weeks. Average best-corrected visual acuity improved from 20/82 at initial presentation to 20/40 after MH closure.

Conclusions : Small full-thickness MHs, especially in previously vitrectomized eyes or those with macular vitreous separation, may benefit from topical medical therapy with steroid, NSAID, and CAI drops. Prospective controlled studies are warranted to further elucidate the use of medical therapy in the treatment of MHs and to better understand if medical treatment could be a conservative alternate to surgery.

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