Abstract
Purpose :
Full-thickness macular holes (FTMHs) are classically treated with pars plana vitrectomy (PPV), but topical steroid, carbonic anhydrase inhibitor (CAI), and nonsteroidal anti-inflammatory (NSAID) have recently been proposed as a less invasive and more cost-effective therapeutic option. This retrospective case series examines the efficacy of topical therapy in the treatment of FTMH, and identifies clinical characteristics associated with successful closure.
Methods :
Retrospective case series of FTMHs diagnosed and treated from 2017-22. Logistic and linear regression models were used to evaluate factors associated with hole closure and final best corrected logMar visual acuity (BCVA), respectively.
Results :
Of 168 patients with FTMHs, 71 patients were started on combination therapy with steroid, CAI, and NSAID drops. 49 patients (avg 67yrs, 59% women) were included in the analysis; 22 were excluded due to poor follow-up. 7/49 were secondary post-PPV holes and 42/49 were idiopathic. 18/49 eyes (36.7%) achieved closure on topical therapy, of which 13 were idiopathic. In cases of successful closure, hole size was directly correlated with odds of closure: for every 10-micron decrease in size, odds of closure increased by 1.2x (p=0.001, CI 1.1-1.4). FTMHs <200um had a closure rate of 72.2% and a 31x odds of closure compared to those >300um (p=0.003, CI 3.17–307). FTMHs 200-300um had a closure rate of 27.8% and a 4.3x odds of closure compared to those >300um (p=0.211, CI 0.44–42.0). Finally, holes >300um had a closure rate of 0%. Average time to closure was 107.2 days (range 20-512 days), and was not correlated to hole size (p=0.217, CI -0.478–+1.938). However, the presence of vitreomacular traction (VMT) was found to be inversely related to successful closure (OR 6.1, CI 1.2-31.3, p=0.029). Finally, amongst patients who received primary PPV (N=18) versus those who underwent and failed a trial of drops before subsequently undergoing a PPV (N=12), there was no significant difference in final BCVA (p=0.856, CI -0.244–+0.292) through a mean follow-up of 60.6 weeks.
Conclusions :
In the first study to-date to report the overall efficacy and clinical characteristics of successful macular hole closure with topical therapy, drops achieved an overall closure rate of 36.7%, with higher efficacy in smaller holes and those without VMT. Delaying PPV by first undergoing a trial of topical therapy did not negatively affect final BCVA.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.