Abstract
Purpose :
Idiopathic macular holes are generally a surgical disease. While small, early macular holes may rarely close spontaneously, most require surgery for repair. Edema surrounding the edge of the hole is thought to be contributory and treating the edema is thought to possibly be able to close the hole. Herein, we report our experience with a non-surgical approach to repairing macular holes.
Methods :
A retrospective chart review of 13 consecutive patients with macular holes from 2018-2021. Topical therapy consisted of a steroid, a non-steroidal and a carbonic anhydrase inhibitor. The setting was a solo retinal surgeon’s practice. Follow-up ranged from 6 months to 2 years.
Data collected included size, stage and duration of macular hole, topical agents used and duration, grading scale of macular edema present, lens status and complications from topical or surgical therapy. The grading scale ranged from 0 (no intraretinal edema at all) to 4 ( maximum, large amount of edema). If the hole failed to close after 3 months of topical therapy, intravitreal Ocriplasmin (Jetrea) was offered and / or vitrectomy with membrane peeling and fluid gas exchange. Best corrected visual acuities (BCVA) were converted to logMAR pre and post hole closure with topical therapy or surgery. SD-OCT images were captured of all patients.
Results :
Seven of the 13 (54%) eyes initially treated topically experienced successful macular hole closure. Small holes (less than 230 microns) with better initial vision (0.474 vs 0.796 logMAR) were more likely to respond favorably to topical therapy (121 microns vs 499 microns). Additionally, holes with less surrounding edema responded better. Of the holes not responding to topical therapy, all were subsequently closed with pars plana vitrectomy (PPV), membrane peel and fluid / gas exchange.
Conclusions :
Topical therapy is a reasonable first line treatment for macular holes with a better than 50% success rate. This is especially true for small, early onset holes with minimal or no edema. There was no apparent deleterious effect of a 1-3 month delay while treating with eye drops as surgery still had a very high success rate.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.