Skip to main content

Advertisement

Log in

Management of Large or Recurrent Macular Holes

  • Retina (R Goldhardt, Section Editor)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review and critically appraise the recent literature about new surgical techniques for the management of large or recurrent macular holes.

Recent Findings

A variety of surgical approaches have recently been developed ranging from autologous retinal grafts to amniotic membrane transplant with varying levels of anatomical and visual success.

Summary

More data is needed to determine if one technique is superior to others. However, with a variety of grafts, adhesives, and tamponades at their disposal, vitreoretinal surgeons have an extensive array of options to approach complex macular holes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Shroff D, Gupta P, Atri N, Gupta C, Shroff C. Inverted internal limiting membrane (ILM) flap technique for macular hole closure: patient selection and special considerations. Clinical Ophthalmology (Auckland, NZ). 2019;13:671–8.

    Article  Google Scholar 

  2. Zhang L, Li X, Yang X, Shen Y, Wu M. Internal limiting membrane insertion technique combined with nerve growth factor injection for large macular hole. BMC Ophthalmol. 2019;19(1):247.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Ali FS, Stein JD, Blachley TS, Ackley S, Stewart JM. Incidence of and risk factors for developing idiopathic macular hole among a diverse group of patients throughout the United States. JAMA Ophthalmol. 2017;135(4):299–305. https://doi.org/10.1001/jamaophthalmol.2016.5870.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gass JD. Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol. 1995;119(6):752–9.

    Article  PubMed  CAS  Google Scholar 

  5. Tanner V, Williamson TH. Watzke-Allen slit beam test in macular holes confirmed by optical coherence tomography. Arch Ophthalmol. 2000 Aug 1;118(8):1059–63.

    Article  PubMed  CAS  Google Scholar 

  6. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611–9.

    Article  PubMed  Google Scholar 

  7. Tam AL, Yan P, Gan NY, Lam WC. The current surgical management of large, recurrent, or persistent macular holes. Retina. 2018;38(7):1263–75.

    Article  PubMed  Google Scholar 

  8. Hess JA, Michels S, Becker MD. Functional and anatomic outcomes of primary and secondary internal limiting membrane transplantation in large and persistent macular holes. Klinische Monatsblatter fur Augenheilkunde. 2018;235(10):1159–64.

    Article  PubMed  Google Scholar 

  9. Yamashita T, Sakamoto T, Terasaki H, Iwasaki M, Ogushi Y, Okamoto F, et al. Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan. Acta Ophthalmol. 2018;96(8):e904–10.

    Article  PubMed  Google Scholar 

  10. Jürgens I, Lipa RK, Pera P. Successful treatment of a retinal detachment secondary to multiple eccentric macular holes with autologous lens capsular flap transplantation. Ophthalmic Surgery, Lasers and Imaging Retina. 2018;49(11):901–3.

    Article  PubMed  Google Scholar 

  11. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010;117(10):2018–25.

    Article  PubMed  Google Scholar 

  12. • Giansanti F, Tartaro R, Caporossi T, Bacherini D, Savastano A, Barca F, Rizzo S. An internal limiting membrane plug and gas endotamponade for recurrent or persistent macular hole. Journal of ophthalmology. 2019; 2019. Small case series examining autologous ILM transplantation. Good overview of outcomes of an alternative, but technically familiar, ILM technique before escalating to more exotic approaches (i.e., retinal flap, capsular graft, AMT).

  13. Abbey AM, Van Laere L, Shah AR, Hassan TS. Recurrent macular holes in the era of small-gauge vitrectomy: a review of incidence, risk factors, and outcomes. Retina. 2017 May 1;37(5):921–4.

    Article  PubMed  Google Scholar 

  14. Rahimy E, McCannel CA. Impact of internal limiting membrane peeling on macular hole reopening: a systematic review and meta-analysis. Retina. 2016;36(4):679–87.

    Article  PubMed  Google Scholar 

  15. Rizzo S, Tartaro R, Barca F, Caporossi T, Bacherini D, Giansanti F. Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina. 2018;38:S73–8.

    Article  PubMed  Google Scholar 

  16. Ramtohul P, Parrat E, Denis D, Lorenzi U. Inverted internal limiting membrane flap technique versus complete internal limiting membrane peeling in large macular hole surgery: a comparative study. BMC Ophthalmol. 2020;20(1):1–8.

    Article  Google Scholar 

  17. Yang YH, Chung YT, Kim BK, Moon JH, Mun SJ. Inverted internal limiting membrane flap technique and an autologous platelet concentrate to treat an Nd: YAG laser-induced macular hole: a case report. Medicine. 2019;98(47):e18185.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Major JJ, Lampen SI, Wykoff CC, Ou WC, Brown DM, Wong TP, Shah AR. The Texas Taco technique for internal limiting membrane flap in large full-thickness macular holes: a short-term pilot study. Retina (Philadelphia, Pa.). 2018

  19. Lytvynchuk LM, Falkner-Radler CI, Krepler K, Glittenberg CG, Ahmed D, Petrovski G, et al. Dynamic intraoperative optical coherence tomography for inverted internal limiting membrane flap technique in large macular hole surgery. Graefes Arch Clin Exp Ophthalmol. 2019;257(8):1649–59.

    Article  PubMed  Google Scholar 

  20. Ghassemi F, Khojasteh H, Khodabande A, Dalvin LA, Mazloumi M, Riazi-Esfahani H, et al. Comparison of three different techniques of inverted internal limiting membrane flap in treatment of large idiopathic full-thickness macular hole. Clinical Ophthalmology (Auckland, NZ). 2019;13:–2599.

  21. Morizane Y, Shiraga F, Kimura S, Hosokawa M, Shiode Y, Kawata T, et al. Autologous transplantation of the internal limiting membrane for refractory macular holes. Am J Ophthalmol. 2014;157(4):861–9.

    Article  PubMed  Google Scholar 

  22. Dai Y, Dong F, Zhang X, Yang Z. Internal limiting membrane transplantation for unclosed and large macular holes. Graefes Arch Clin Exp Ophthalmol. 2016;254(11):2095–9.

    Article  PubMed  CAS  Google Scholar 

  23. Primavera V, Centoducati T, Agea L, Zucchiatti I, Querques L, Querques G. Pilot evaluation of a new surgical technique for persistent or recurrent large macular holes. Ophthalmic Surgery, Lasers and Imaging Retina. 2018;49(4):266–8.

    Article  PubMed  Google Scholar 

  24. Ra H, Lee WK. Contralateral autologous internal limiting membrane transplantation for closure of a refractory macular hole: surgical technique. Ophthalmic Surgery, Lasers and Imaging Retina. 2018;49(9):e75–7.

    Article  PubMed  Google Scholar 

  25. Vieregge M, Valmaggia C, Scholl HP, Guber J. Microstructural retinal regeneration after internal limiting membrane flap surgery for repair of large macular holes: a 1-year follow-up study. Int Ophthalmol. 2019;39(6):1277–82.

    Article  PubMed  Google Scholar 

  26. Wu AL, Chuang LH, Wang NK, Chen KJ, Liu L, Yeung L, et al. Refractory macular hole repaired by autologous retinal graft and blood clot. BMC Ophthalmol. 2018;18(1):213.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chen SN, Yang CM. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies. Retina. 2016;36(1):163–70.

    Article  PubMed  Google Scholar 

  28. Peng J, Chen C, Jin H, Zhang H, Zhao P. Autologous lens capsular flap transplantation combined with autologous blood application in the management of refractory macular hole. Retina. 2018;38(11):2177–83.

    Article  PubMed  Google Scholar 

  29. Grewal DS, Mahmoud TH. Autologous neurosensory retinal free flap for closure of refractory myopic macular holes. JAMA Ophthalmol. 2016;134(2):229–30. https://doi.org/10.1001/jamaophthalmol.2015.5237.

    Article  PubMed  Google Scholar 

  30. De Giacinto C, D’Aloisio R, Cirigliano G, Pastore MR, Tognetto D. Autologous neurosensory retinal free patch transplantation for persistent full-thickness macular hole. Int Ophthalmol. 2019;39(5):1147–50.

    Article  PubMed  Google Scholar 

  31. • Grewal DS, Charles S, Parolini B, Kadonosono K, Mahmoud TH. Autologous retinal transplant for refractory macular holes: Multicenter International Collaborative Study Group. Ophthalmology. 2019;126(10):1399–408 A multi-center retrospective study on the neurosensory retinal flap that demonstrates the visual and anatomic outcomes of this technique and general recommendations on how to approach it surgically.

    Article  PubMed  Google Scholar 

  32. Neves FS, Braga J, Sepúlveda P, Bilhoto M. Refractory myopic retinal detachment and macular hole closure with autologous neurosensory retinal free flap. Case reports in ophthalmology. 2019;10(2):160–4.

    Article  Google Scholar 

  33. Chang YC, Liu PK, Kao TE, Chen KJ, Chen YH, Chiu WJ, Wu KY, Wu WC. Management of refractory large macular hole with autologous neurosensory retinal free flap transplantation. Retina. 2019.

  34. Ding C, Li S, Zeng J. Autologous neurosensory retinal transplantation for unclosed and large macular holes. Ophthalmic Res. 2019;61(2):88–93.

    Article  PubMed  Google Scholar 

  35. Tanaka S, Inoue M, Inoue T, Yamakawa T, Uchio E, Grewal DS, Mahmoud TH, Kadonosono K. Autologous retinal transplantation as a primary treatment for large chronic macular holes. Retina. 2019.

  36. Caporossi T, Pacini B, De Angelis L, Barca F, Peiretti E, Rizzo S. Human amniotic membrane to close recurrent, high myopic macular holes in pathologic myopia with axial length of ≥ 30 mm. Retina (Philadelphia, Pa.). 2019.

  37. Rizzo S, et al. A human amniotic membrane plug to promote retinal breaks repair and recurrent macular hole closure. Retina. 2019;39:S95–S103.

    Article  PubMed  Google Scholar 

  38. Charles S, Randolph JC, Neekhra A, Salisbury CD, Littlejohn N, Calzada JI. Arcuate retinotomy for the repair of large macular holes. Ophthalmic Surgery, Lasers and Imaging Retina. 2013;44(1):69–72.

    Article  PubMed  Google Scholar 

  39. Reis R, Ferreira N, Meireles A. Management of stage IV macular holes: when standard surgery fails. Case reports in ophthalmology. 2012;3(2):240–50.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Karacorlu M, Muslubas IS, Hocaoglu M, Arf S, Ersoz MG. Double arcuate relaxing retinotomy for a large macular hole. Retinal Cases and Brief Reports. 2019;13(2):167–70.

    Article  PubMed  Google Scholar 

  41. Knight D, Yu JJ, Adrean SD. Relaxing nasal retinotomy technique for closure of a macular hole that reopened after primary vitrectomy. Retinal cases & brief reports. 2019

  42. Felfeli T, Mandelcorn ED. Macular hole hydrodissection: surgical technique for the treatment of persistent, chronic, and large macular holes. Retina. 2019;39(4):743–52.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jayanth Sridhar.

Ethics declarations

Conflict of Interest

Hailey Kay Robles-Holmes, Patrick C. Staropoli, and Nicolas Yannuzzi each declare no potential conflicts of interest. Jayanth Sridhar reports personal fees from Alcon, Regeneron, Oxurioin, and Alimera.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Retina

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Robles-Holmes, H.K., Staropoli, P.C., Yannuzzi, N. et al. Management of Large or Recurrent Macular Holes. Curr Ophthalmol Rep 8, 62–68 (2020). https://doi.org/10.1007/s40135-020-00231-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40135-020-00231-3

Keywords

Navigation