What is the recommended treatment for a full thickness macular hole?

What is the recommended treatment for a full thickness macular hole?

• A. Impending hole - monitor; Full thickness hole - PPV with ILM peel and gas tamponade
• B. Laser photocoagulation for all holes
• C. Observation only
• D. Medical therapy with steroids

Answer: (A)

Full-thickness macular holes are caused by tractional forces at the fovea that create a defect through all retinal layers. The standard treatment is pars plana vitrectomy with removal of the vitreous gel, peeling of the internal limiting membrane around the hole, and gas tamponade. Removing the vitreous eliminates the anteroposterior traction that keeps the hole open; peeling the ILM relieves residual tangential traction and promotes a healing response that helps the hole close; and the gas tamponade provides internal support to keep the hole edges pressed together during the healing process, with postoperative positioning to maximize contact. Laser photocoagulation isn’t a proven method to close macular holes and can damage central retina. Observation alone is not appropriate for a full-thickness hole, as spontaneous closure is unlikely once the hole has formed. Steroid therapy has no role in closing macular holes.

Full-thickness macular holes are caused by tractional forces at the fovea that create a defect through all retinal layers. The standard treatment is pars plana vitrectomy with removal of the vitreous gel, peeling of the internal limiting membrane around the hole, and gas tamponade. Removing the vitreous eliminates the anteroposterior traction that keeps the hole open; peeling the ILM relieves residual tangential traction and promotes a healing response that helps the hole close; and the gas tamponade provides internal support to keep the hole edges pressed together during the healing process, with postoperative positioning to maximize contact.

Laser photocoagulation isn’t a proven method to close macular holes and can damage central retina. Observation alone is not appropriate for a full-thickness hole, as spontaneous closure is unlikely once the hole has formed. Steroid therapy has no role in closing macular holes.