A full-thickness macular hole (MH) is a full-thickness break within the fovea that can cause decreased vision. |
Primary surgery for MH has a high success rate with current methods of pars plana vitrectomy and internal limiting membrane (ILM) peeling. |
When primary surgery fails, several secondary surgical options exist for recurrent or persistent MHs. |
In this review, we discuss each surgical technique in detail. |
Introduction
Risk Factors for Failure of Primary Macular Hole Surgery
Surgical method | Authors | # of eyes (n) | MH size/stage | Closure rate | Improvement in vision (pre-op to post-op) | Follow-up period |
---|---|---|---|---|---|---|
ILM peeling | Kelly and Wendel [36] | 52 | Not reported | 58% | 73% of holes that closed—2 lines or better | Not reported |
Eckardt et al. [15] | 39 | Not reported | 92% | 77% of hole that closed—2 lines or better | Not reported | |
Park et al. [37] | 58 | 14% stage 2, 83% stage 3, 3% stage 4 | 91% | 9% initial visual acuity 20/50 or better; 53% final visual acuity 20/50 or better | At least 6 months; mean 696 days (range, 180–1869 days) | |
Haritoglou et al. [17] | 64 | 8% stage 2, 73% stage 3, 19% stage 4 | 95% | Median visual acuity improved from 20/100 to 20/32; median gain of 5 lines | At least 36 months; mean 56 months (range, 36–75 months) | |
Enlargement of ILM rhexis | D’Souza et al. [44] | 30 | Not reported | 47% (reoperation) | 88% no improvement, 8% improved by 2 lines, 4% improved by 4 lines (n = 25 with follow-up data) | Not reported |
Che et al. [46] | 13 | Mean 584 ± 89 µm | 62% (reoperation) | Mean logMAR visual acuity improved from 0.98 to 0.84 | 6 months | |
Inverted ILM flap | Michalewska et al. [47] | 50 (7 failed attempts) | Mean minimum hole diameter 759 µm, mean maximum hole diameter 1595 µm | 98% (n = 43) | Mean visual acuity improved from 0.078 to 0.28 | 12 months |
Rizzo et al. [48] | 320 | MH size subcategorized into 2 groups: < 400 µm and > 400 µm | 92% overall; 97% for MH < 400 µm, 96% for MH > 400 µm | Mean visual acuity improved from 20/110 to 20/54 | Mean 9.3 months ± 2.0 SD | |
Kannan et al. [52] | 30 | Mean base diameter 1395.17 ± 240.56 µm | 90% | Mean improvement 2.1 lines of visual acuity | 6 months | |
Narayanan et al. [53] | 18 | Mean diameter 1162.8 ± 206.0 µm | 89% | Mean visual acuity improved from 20/270 to 20/120 | 6 months | |
Free ILM flap | Morizane et al. [57] | 10 | Mean diameter 509.3 ± 137.8 µm | 90% | Mean visual acuity improved from 0.99 ± 0.25 to 0.57 ± 0.36 | Mean 12 ± 5 months |
Dai et al. [60] | 13 | Mean minimum diameter 814.4 ± 255.0 µm, mean base diameter 1637.6 ± 412.7 µm | 92% | Mean visual acuity improved from 1.15 ± 0.21 to 0.99 ± 0.17 | 12 months | |
Pires et al. [58] | 12 | Mean minimum diameter 654.9 ± 196.5 µm, mean base diameter 1662.7 ± 688.5 µm | 91% (reoperation) | Mean visual acuity improved from 20/400 to 20/160 | 12 months | |
Lens capsule transplant | Chen and Yang [64] | 20 | Mean diameter 788.8 ± 198.1 µm | 75% (reoperation) | Mean logMAR visual acuity improved from 1.53 ± 0.39 to 1.07 ± 0.35 | Not reported |
Peng et al. [65] | 50 | Mean diameter 1102.0 ± 561.6 µm | 96% | Median logMAR visual acuity improved from 1.78 to 1.00 | Mean 18.5 ± 6.1 months | |
Autologous retinal transplant | Grewal et al. [67] | 41 | Mean inner-opening diameter 825 ± 422.5 µm, mean base diameter 1468.1 ± 656.4 µm | 87.8% (reoperation) | Mean logMAR visual acuity improved from 1.11 ± 0.66 to 1.03 ± 0.51 | Mean 11.1 ± 7.7 months |
Chang et al. [69] | 10 | Mean diameter 1404.2 ± 562.9 µm | 90% (reoperation) | Mean logMAR visual acuity improved from 1.65 ± 0.43 to 0.88 ± 0.49 | 12 months | |
Tanaka et al. [70] | 7 | Mean minimum hole diameter 643 µm, mean maximum hole diameter 1214 µm | 100% | Mean logMAR visual acuity improved from 1.10 to 0.68 | 12 months | |
Rojas-Juárez et al. [71] | 13 | Mean minimum diameter 964.38 ± 709.77 µm, mean base diameter 1615.38 ± 689.19 µm | 76.9% | Mean logMAR visual acuity improved from 0.92 ± 0.28 to 0.75 ± 0.29 (not statistically significant) | 12 months | |
Amniotic membrane transplant | Caporossi et al. [73] | 20 (10 in SF6 group, 10 in air group) | SF6 group: mean minimum diameter 779.8 ± 142.53 µm; air group: mean minimum diameter 799 ± 175.18 µm | 100% | SF6 group: mean visual acuity improved from 20/400 to 20/63; air group: mean visual acuity improved from 20/250 to 20/63 | 12 months |
Ferreira et al. [75] | 19 | Mean base diameter 1301 ± 742 µm, mean minimum diameter 856 ± 459 µm | 100% | Mean logMAR visual acuity improved from 1.30 ± 0.44 to 1.0 ± 0.72 | Mean 9 ± 3.87 months | |
Autologous platelet concentrate | Gaudric et al. [78] | 20 | 15% stage 2, 55% stage 3, 30% stage 4 | 95% | Mean visual acuity improved from 0.18 to 0.43 | 6 months |
Paques et al. [79] | 53 | 85% stage 3 | 98% | Mean gain of 7.3 ETDRS (Early Treatment Diabetic Retinopathy Study) letters compared to baseline | 1 month | |
Vote et al. [80] | 70 | 20% stage 2, 74% stage 3, 6% stage 4 | 98.5% | 77% improved at least 2 Snellen lines; mean improvement of 4 lines | Not reported | |
Cheung et al. [81] | 56 | 8 were stage 2, 36 were stage 3, 12 were stage 4 | 98.2% | 66.1% improved at least 2 Snellen lines | Variable: < 6 months in 37 patients, 12 months in 16 patients, 18 months in 1 patient, > 18 months in 2 patients | |
Subretinal blebs | Meyer et al. [85] | 41 | Mean aperture diameter 1212 µm, mean base diameter 649 µm | 85.4% | Mean visual acuity improved from 0.1 to 0.22 | 6 weeks |
Felfeli and Mandelcorn [87] | 39 | Mean aperture diameter 549.1 ± 159.47 µm, mean base diameter 941.97 ± 344.14 µm | 87.2% | 79.5% improved at least 2 Snellen lines | Mean 320.33 ± 269.04 | |
Retinal relaxing incisions | Charles et al. [88] | 6 | Mean diameter 658 ± 180 µm | 83% (reoperation) | 3 patients experienced improvement in vision | Mean 26.5 months (range 1 to 70 months) |
Reis et al. [89] | 7 | MH diameter range 455 to 750 µm | 100% (reoperation) | All patients experienced improvement in vision | Mean 12 months (range 5–24 months) |