ASRS 2023: Clinical characteristics of macular holes that close without surgery

J. Fernando Arevalo, MD, PhD, FACS, FASRS, spoke with our team about clinical characteristics of macular holes that close without surgery at the 2023 ASRS annual meeting.

Video Transcript

Editor's note - This transcript has been edited for clarity.

J. Fernando Arevalo, MD, PhD, FACS, FASRS:

Hello, my name is Fernando Arevalo, and I'm a Professor of Ophthalmology at Johns Hopkins University and Wilmer Eye Institute in Baltimore, Maryland. I'm here at ASRS in Seattle, and 1 of the things I have presented on is clinical characteristics of macular holes that close without surgery. This is a multicenter study, worldwide readiness origins contributed. But, I'd like to acknowledge 1 of our research fellows, Hana Mansour We know that macular holes mainstay of treatment surgery.

The vitrectomy with ILM peeling and gas with face-down positioning closes over 90% of the macular holes. However, there is a subset of patients that will close without surgery. There are reports that show a small percentage of cases and we wanted to look in this history at the clinical and anatomic characteristics of those full thickness, macular holes that close up spontaneously. We [inaudible] the spectral domain OCT's of those macular holes that closed without surgery from Worldwide International Group. We used an imaging software to account for the differences in different machines of OCT, and 2 masked readers evaluated the OCT's for these macular holes. So, we found 78 patients with 78 full thickness macular holes that closed without surgery. 18 were associated to a blunt trauma, [and] 18 were associated to topical treatment with corticosteroids and non-steroidal, anti-inflammatory drugs. We saw an improvement in visual acuity that was significant. Of the holes that closed, 7 of those reopened, that's about 9% of the holes, and they were closed again, 2 of them with surgery, 1 with topical NSAIDs for refusal [to] any surgical procedure. But from the anatomic point of view, we found a correlation between the height and the diameter of the macular hole in terms of visual acuity improvement.

Also, closure of the macular hole was associated with the thickness of the macular hole and the size of the macular hole in terms of the basal diameter. In summary, for this study, we feel that if patients have had blown ocular trauma, it is a good idea to give them some time of observation, especially if the patient has a macular hole associated with cystoid macular edema and a macular hole that is smaller than 200 microns. Thank you for the opportunity to share this information with you.