It may be reasonable to observe, rather than immediately treat, recent onset macular holes for the possibility that they will close without surgery, a research team is suggesting. This is especially true in the event of blunt ocular trauma, according to results published in the British Journal of Ophthalmology. Study results also support nonsurgical sealing of full thickness macular holes for individuals with cystic characteristics under treatment. 

A team of international investigators conducted a retrospective multicenter collaborative study to assess the anatomic characteristics that help enable nonsurgical sealing in full thickness macular holes. 

The analysis included 78 patients (mean age, 57.9 years; 47 men); 18 patients had blunt ocular trauma, 18 patients received topical or intravitreal therapies, and 42 patients had idiopathic full thickness macular holes. Patients were either awaiting surgery, denied surgery and returned with improved vision, or were placed on initial observation (traumatic category). 


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After initial detection, the mean time to closure was 6.2±10.8 months. At a mean follow-up of 33.8±37.1 months, the average initial corrected visual acuity improved from 0.65±0.54 logMAR to 0.34±0.45 logMAR (P <.001). 

The researchers reported vitreomacular traction in 12 eyes, perifoveal posterior vitreous detachment in 42 eyes, foveal epiretinal membrane in 10 eyes, cystoid macular edema in 49 eyes, and subretinal fluid in 20 eyes; 7 eyes had reopened full thickness macular holes. 

In a multivariate analysis, the initial visual acuity was related to the height and narrowest diameter of the hole (P <.001 for both), and the final visual acuity was related to the basal diameter (P <.001). 

The time for closure of full thickness macular holes was associated with the narrowest diameter (P <.001) and the presence of subretinal fluid (P =.001). 

The mean time of closure was the shortest for eyes with trauma (1.6 month), followed by eyes without trauma but with therapy for cystoid macular edema (4.3 months), eyes without trauma or therapy less than 200 µm in size (4.4 months), and eyes without trauma or therapy more than 200 µm in size (24.7 months).

Some study limitations included its retrospective design, the lack of comprehensive data about the precise onset of full thickness macular holes in some cases, the short follow-up, and the potential for referral bias. 

“Periodic re-examination and following with serial [ocular coherence tomography] can reveal progressive narrowing and subsequent closure of FTMH, thus potentially avoiding the need for surgical intervention; enlarging FTMH are more clearly candidates for prompt vitrectomy,” according to the investigation. 

Reference 

Uwaydat SH, Mansour A, Ascaso FJ, et al. Clinical characteristics of full thickness macular holes that closed without surgery. Br J Ophthalmol. Published online April 29, 2021. doi:10.1136/bjophthalmol-2021-319001