Vitreous surgery for idiopathic macular holes. Results of a pilot study

N. E. Kelly and R. T. Wendel
Mercy Eye Foundation, Sacramento, Calif.

Idiopathic macular holes are generally considered an untreatable condition. We used modern vitrectomy techniques to evaluate two questions: (1) Is it possible to reattach the retina around the macular hole? (2) If it is reattached, will the patient's central vision improve? In 30 (58%) of 52 patients, we were able to reattach successfully the detached macula with our surgical procedure. In 22 (73%) of the 30 patients in whom the macula was successfully reattached, there was an improvement in visual acuity of two lines or better. In the 22 patients in whom reattachment of the macular hole was not obtained, there was no significant improvement in visual acuity. Thus, the overall success rate for improved vision postoperatively was 42% (22/52). Complications related to surgery were observed in eight patients (15%) early in our experience with this procedure and included increase in the size of the macular hole, mottling of the retinal pigmented epithelium, and a vascular occlusion. Our clinical observations indicate that the treatment of macular holes by vitrectomy may offer some promise for this otherwise untreatable condition. In patients in whom reattachment was successful, the technique used appeared to allow for clinically significant improvements in visual acuity. However, additional work on increasing surgical success and minimizing surgical complications, as well as a further understanding of the mechanism of retinal reattachment, is required before widespread use of this procedure for treating macular holes.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Early foveal recovery after macular hole surgery
Hasler and Prunte
Br. J. Ophthalmol. 2008;92:645-649.
ABSTRACT | FULL TEXT  

Sharp dissection of the Weiss ring to induce a posterior vitreous detachment
Desai et al.
Br. J. Ophthalmol. 2008;92:420-422.
ABSTRACT | FULL TEXT  

Retreatment of full-thickness macular hole: predictive value of optical coherence tomography
Hillenkamp et al.
Br. J. Ophthalmol. 2007;91:1445-1449.
ABSTRACT | FULL TEXT  

Incidence of retinal detachment after macular surgery: a retrospective study of 634 cases
Guillaubey et al.
Br. J. Ophthalmol. 2007;91:1327-1330.
ABSTRACT | FULL TEXT  

The role of heredity in determining central retinal thickness
Liew et al.
Br. J. Ophthalmol. 2007;91:1143-1147.
ABSTRACT | FULL TEXT  

The 100 Most Frequently Cited Articles in Ophthalmology Journals
Ohba et al.
Arch Ophthalmol 2007;125:952-960.
ABSTRACT | FULL TEXT  

Visual quality of life after macular hole surgery: outcome and predictive factors
Hirneiss et al.
Br. J. Ophthalmol. 2007;91:481-484.
ABSTRACT | FULL TEXT  

Relationship between macular hole size and the potential benefit of internal limiting membrane peeling.
Williams
Br. J. Ophthalmol. 2006;90:1216-1217.
FULL TEXT  

Ultrahigh-resolution optical coherence tomography of surgically closed macular holes.
Ko et al.
Arch Ophthalmol 2006;124:827-836.
ABSTRACT | FULL TEXT  

The macular hole: histopathologic studies.
Green
Arch Ophthalmol 2006;124:317-321.
ABSTRACT | FULL TEXT  

Safety of In Vivo Pharmacologic Vitreolysis with Recombinant Microplasmin in Rabbit Eyes
Sakuma et al.
IOVS 2005;46:3295-3299.
ABSTRACT | FULL TEXT  

Chemical Toxicity of Indocyanine Green Damages Retinal Pigment Epithelium
Ikagawa et al.
IOVS 2005;46:2531-2539.
ABSTRACT | FULL TEXT  

Let green lead not astray
Sebag
Br. J. Ophthalmol. 2005;89:790-792.
FULL TEXT  

Surgery for Idiopathic Full-Thickness Macular Hole: Two-Year Results of a Randomized Clinical Trial Comparing Natural History, Vitrectomy, and Vitrectomy Plus Autologous Serum: Moorfields Macular Hole Study Group Report No. 1
Ezra and Gregor
Arch Ophthalmol 2004;122:224-236.
ABSTRACT | FULL TEXT  

Types of macular hole closure and their clinical implications
Kang et al.
Br. J. Ophthalmol. 2003;87:1015-1019.
ABSTRACT | FULL TEXT  

Internal limiting membrane removal in macular hole surgery for severely myopic eyes: a case-control study
Kwok and Lai
Br. J. Ophthalmol. 2003;87:885-889.
ABSTRACT | FULL TEXT  

Retinal Damage from Indocyanine Green in Experimental Macular Surgery
Gandorfer et al.
IOVS 2003;44:316-323.
ABSTRACT | FULL TEXT  

Indocyanine green assisted retinal internal limiting membrane removal in stage 3 or 4 macular hole surgery
Kwok et al.
Br. J. Ophthalmol. 2003;87:71-74.
ABSTRACT | FULL TEXT  

Macular hole size as a prognostic factor in macular hole surgery
Ullrich et al.
Br. J. Ophthalmol. 2002;86:390-393.
ABSTRACT | FULL TEXT  

Anatomical Outcomes of Surgery for Idiopathic Macular Hole as Determined by Optical Coherence Tomography
Ip et al.
Arch Ophthalmol 2002;120:29-35.
ABSTRACT | FULL TEXT  

New Visual Acuity Chart for Patients with Macular Hole
Horiguchi et al.
IOVS 2001;42:2765-2768.
ABSTRACT | FULL TEXT  

Optic Disc, Foveal, and Extrafoveal Damage Due to Surgical Separation of the Vitreous
Russell and Hageman
Arch Ophthalmol 2001;119:1653-1658.
ABSTRACT | FULL TEXT  

Phacovitrectomy without prone posture for full thickness macular holes
Simcock and Scalia
Br. J. Ophthalmol. 2001;85:1316-1319.
ABSTRACT | FULL TEXT  

Macular hole surgery using silicone oil tamponade
Karia et al.
Br. J. Ophthalmol. 2001;85:1320-1323.
ABSTRACT | FULL TEXT  

Serous Retinal and Choroidal Detachment After Macular Hole Surgery
Garcia-Valenzuela and Eliott
Arch Ophthalmol 2001;119:1379-1380.
FULL TEXT  

Optical coherence tomography of the vitreoretinal interface in macular hole formation
Tanner et al.
Br. J. Ophthalmol. 2001;85:1092-1097.
ABSTRACT | FULL TEXT  

Peripheral visual field defects after macular hole surgery: a complication with decreasing incidence
Gass et al.
Br. J. Ophthalmol. 2001;85:549-551.
ABSTRACT | FULL TEXT  

Immunocytochemical Characterization of Macular Hole Opercula
Ezra et al.
Arch Ophthalmol 2001;119:223-231.
ABSTRACT | FULL TEXT  

Effectiveness of apraclonidine 1% in preventing intraocular pressure rise following macular hole surgery
Sciscio and Casswell
Br. J. Ophthalmol. 2001;85:164-168.
ABSTRACT | FULL TEXT  

Paracentral scotomata: a new finding after vitrectomy for idiopathic macular hole
Haritoglou et al.
Br. J. Ophthalmol. 2001;85:231-233.
ABSTRACT | FULL TEXT  

Anticipation for enzymatic vitreolysis
BHISITKUL
Br. J. Ophthalmol. 2001;85:1-2.
FULL TEXT  

Spontaneous closure of a macular hole secondary to an accidental laser injury
NEWMAN and FLANAGAN
Br. J. Ophthalmol. 2000;84:1075-1075.
FULL TEXT  

Watzke-Allen Slit Beam Test in Macular Holes Confirmed by Optical Coherence Tomography
Tanner and Williamson
Arch Ophthalmol 2000;118:1059-1063.
ABSTRACT | FULL TEXT  

Staining of Internal Limiting Membrane in Macular Hole Surgery
Kadonosono et al.
Arch Ophthalmol 2000;118:1116-1118.
ABSTRACT | FULL TEXT  

Effect of Perifoveal Tissue Dissection in the Management of Acute Idiopathic Full-Thickness Macular Holes
Margherio et al.
Arch Ophthalmol 2000;118:495-498.
ABSTRACT | FULL TEXT  

Prevention of visual field defects after macular hole surgery
Cullinane and Cleary
Br. J. Ophthalmol. 2000;84:372-377.
ABSTRACT | FULL TEXT  

Human Platelet Suspension Stimulates Porcine Retinal Glial Proliferation and Migration In Vitro
Castelnovo et al.
IOVS 2000;41:601-609.
ABSTRACT | FULL TEXT  

Scanning Laser Ophthalmoscope Correlations With Biomicroscopic Findings and Foveal Function After Macular Hole Closure
Hikichi et al.
Arch Ophthalmol 2000;118:193-197.
ABSTRACT | FULL TEXT  

Visual and anatomical results of surgery for long standing macular holes
Scott et al.
Br. J. Ophthalmol. 2000;84:150-153.
ABSTRACT | FULL TEXT  

The Visual Performance and Metamorphopsia of Patients With Macular Holes
Saito et al.
Arch Ophthalmol 2000;118:41-46.
ABSTRACT | FULL TEXT  

A Multicentered Clinical Study of Serum as Adjuvant Therapy for Surgical Treatment of Macular Holes
Banker et al.
Arch Ophthalmol 1999;117:1499-1502.
ABSTRACT | FULL TEXT  

Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole
Chang et al.
Br. J. Ophthalmol. 1999;83:944-948.
ABSTRACT | FULL TEXT  

Macular Hole Formation: New Data Provided by Optical Coherence Tomography
Gaudric et al.
Arch Ophthalmol 1999;117:744-751.
ABSTRACT | FULL TEXT  

Histopathological Features of Vitreous Removed at Macular Hole Surgery
Sadda et al.
Arch Ophthalmol 1999;117:478-484.
ABSTRACT | FULL TEXT  

Trends in vitreoretinal surgery---time to stop and think
LEAVER
Br. J. Ophthalmol. 1999;83:385-386.
FULL TEXT  

Trends in vitreoretinal surgery at a tertiary referral centre: 1987 to 1996
Ah-Fat et al.
Br. J. Ophthalmol. 1999;83:396-398.
ABSTRACT | FULL TEXT  

Clinical Course of Macular Holes: The Eye Disease Case-Control Study
Chew et al.
Arch Ophthalmol 1999;117:242-246.
ABSTRACT | FULL TEXT  

Macular Hole: A Continuing Saga
Fine
Arch Ophthalmol 1999;117:248-249.
FULL TEXT  

Long-term Follow-up of Iatrogenic Phototoxicity
Postel et al.
Arch Ophthalmol 1998;116:753-757.
ABSTRACT | FULL TEXT  

Spontaneous Resolution of Retinal Detachment Occurring After Macular Hole Surgery
Akduman et al.
Arch Ophthalmol 1998;116:465-467.
ABSTRACT | FULL TEXT  

Fundus autofluorescence in patients with macular holes imaged with a laser scanning ophthalmoscope
von Rückmann et al.
Br. J. Ophthalmol. 1998;82:346-351.
ABSTRACT | FULL TEXT  

Surgical management of macular holes: results using gas tamponade alone, or in combination with autologous platelet concentrate, or transforming growth factor beta 2
Minihan et al.
Br. J. Ophthalmol. 1997;81:1073-1079.
ABSTRACT | FULL TEXT  

Vitrectomy and autologous thrombocyte adhesion of an accidental macular hole caused by Nd:YAG laser
POTTHOFER and FOERSTER
Br. J. Ophthalmol. 1997;81:802b-802.
FULL TEXT  

Late reopening of successfully treated macular holes
Paques et al.
Br. J. Ophthalmol. 1997;81:658-662.
ABSTRACT | FULL TEXT  

Macular holes viewed objectively
GREGOR
Br. J. Ophthalmol. 1997;81:98-99.
FULL TEXT  

Differentiating full thickness macular holes from impending macular holes and macular pseudoholes
Tsujikawa et al.
Br. J. Ophthalmol. 1997;81:117-122.
ABSTRACT | FULL TEXT