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Anna Mackin, Jared Sokol, Rahul Komati, Sidney A Schechet, Asim Farooq, Dimitra Skondra MD,PhD; Medical Treatment of Full-Thickness Macular Holes with Drop Regimen – The University of Chicago Experience. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4379.
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Idiopathic full-thickness macular holes, commonly managed by retina specialists, usually require surgery to achieve closure. We describe our institutional experience in macular hole closure with non-surgical management.
Case series of patients with idiopathic full-thickness macular holes that closed with topical drops at the University of Chicago by a single retina specialist 1/1/2017-8/1/2019 (DS). IRB-approved retrospective chart review included demographics, best-corrected visual acuity (BCVA), macular hole characteristics based on spectral domain optical coherence tomography (OCT), medication regimen, side effects, and status of macular hole following treatment. The regimen included a combination of topical ophthalmic corticosteroid, non-steroidal anti-inflammatory (NSAID), and carbonic anhydrase inhibitor (CAI) drops, and oral CAI in select cases.
11 patients (11 eyes), 7 female/4 male with average age of 65.7 years were included. Mean follow-up time was 44.8 weeks. At diagnosis mean BCVA was 0.48 logMAR (20/60), mean macular hole diameter was 194 micrometers. Four patients had prior vitrectomy. OCT at diagnosis showed fine epiretinal membrane in 8 patients, cystoid hydration in 11 patients, vitreomacular traction in 2 patients. The drop regimen was: ketorolac 4 times/day in all; prednisolone acetate 4 times/day in 9, 6 times/day in 1 patient; difluprednate 4 times/day in 1 patient; brinzolamide 3 times/day in 9 patients, dorzolamide three times/day in 2 patients. Oral acetazolamide was used in 4 patients who did not achieve hole closure with drops alone. Median time to hole closure was 12.0 weeks (range 2-45). Mean BCVA following hole closure was 0.24 logMAR (20/35). 6 patients developed intraocular pressure (IOP) elevation attributed to corticosteroid use, managed medically in all (topical drops in 5, topical drops and oral acetazolamide in 1 patient), normalized upon corticosteroid discontinuation. 2 patients had no IOP data available. Oral acetazolamide was associated with hypokalemia in 1 and dizziness in 2 patients which resolved upon discontinuation. 3 patients had cataract surgery during macular hole treatment.
In our experience idiopathic full-thickness macular holes characterized by diameter < 200 micrometers with cystoid hydration can achieve closure with medical therapy including topical corticosteroid, NSAID and CAI drops and oral CAI.
This is a 2020 ARVO Annual Meeting abstract.
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