Optimal management of idiopathic macular holes

Clinical Ophthalmology
Haifa A MadiDavid H W Steel

Abstract

This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the ...Continue Reading

Citations

Jun 14, 2019·Journal of Ophthalmology·Guzel BikbovaKeisuke Mori
Apr 16, 2019·Journal of Ophthalmology·Chiara De GiacintoDaniele Tognetto
Jan 11, 2018·Vestnik oftalmologii·A N SamoylovP A Samoylova

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