Two Cases of Macular Hole Closure with Topical Medical Treatment

Background

Full-thickness macular holes (FTMHs) are foveal neurosensory defects that affect all layers of the neurosensory retina and tend to increase in size with time.

FTMHs are evaluated by optical coherence tomography (OCT). The International Vitreomacular Traction Study Group classifies macular holes according to their size (small, medium, or large) and their vitreous status as determined by OCT, differentiating between the presence or absence of vitreomacular traction (VMT) [1]. FTMHs can be further subdivided according to their etiology into primary and secondary forms. Primary FTMHs are the result of vitreous traction. Secondary FTMHs differ in etiopathogenesis since VMT is not the primary reason for the macular hole development. These secondary macular holes are seen, for instance, in high myopia (myopic macular hole), in macular telangiectasia (MacTel), in cystoid macular edema caused by several retinal diseases such as retinal vein occlusion, diabetic retinopathy, and posterior uveitis, in proliferative diabetic retinopathy, and in solar maculopathy.

The current treatment for FTMHs is combined pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling with consecutive gas or air tamponade. Cases of spontaneous closure of predominantly smaller FTMHs have been described in the literature [2]. The reported spontaneous closure rate for small FTMHs (< 250 µm, measured by OCT) without VMT is between 4 and 11.5% [3].

Emerging evidence suggests that topical treatment with carbonic anhydrase inhibitors (CAIs), steroids, and/or nonsteroidal anti-inflammatory (NSAID) drugs can lead to closure of small FTMHs without surgical intervention [4]. As FTMHs can close spontaneously, especially smaller macular holes, the best time point for a PPV or ILM peeling remains unclear. Furthermore, the benefit of delaying a surgical intervention and treating the patient with topical eye drops to increase the chance of closure remains to be elucidated [5].

We report our first two consecutive cases of FTMH closure under topical treatment at the University Hospital Basel, Switzerland.

Publication History

Received: 17 December 2022

Accepted: 14 February 2023

Article published online:
25 April 2023

• References

• 1 Duker JS, Kaiser PK, Binder S. et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 2013; 120: 2611-2619 DOI: 10.1016/j.ophtha.2013.07.042.
• 2 Lai MM, Bressler SB, Haller JA. Spontaneous resolution of macular microhole. Am J Ophthalmol 2006; 141: 210-212 DOI: 10.1016/j.ajo.2005.07.074.
• 3 Liang X, Liu W. Characteristics and Risk Factors for Spontaneous Closure of Idiopathic Full-Thickness Macular Hole. J Ophthalmol 2019; 2019: 4793764 DOI: 10.1155/2019/4793764.
• 4 Sokol JT, Schechet SA, Komati R. et al. Macular Hole Closure with Medical Treatment. Ophthalmol Retina 2021; 5: 711-713 DOI: 10.1016/j.oret.2020.11.018.
• 5 Nawrocka Vel Michalewska ZA, Nawrocka Z, Nawrocki J. Spontaneous Closure of Full-Thickness Macular Holes. Ophthalmologica 2022; 245: 49-58 DOI: 10.1159/000516768.
• 6 Niffenegger JH, Fong DS, Wong KL. et al. Treatment of Secondary Full-Thickness Macular Holes with Topical Therapy. Ophthalmol Retina 2020; 4: 695-699 DOI: 10.1016/j.oret.2020.01.014.
• 7 Kurz PA, Kurz DE. Macular hole closure and visual improvement with topical nonsteroidal treatment. Arch Ophthalmol 2009; 127: 1687-1688 DOI: 10.1001/archophthalmol.2009.328.
• 8 Idoate A, Honrrubia A, Ascaso J. et al. Resolution of postoperative macular hole with topical nepafenac: a case report. Acta Ophthalmologica 2015; DOI: 10.1111/j.1755-3768.2015.0524.
• 9 Gonzalez-Saldivar G, Juncal V, Chow D. Topical steroids: A non-surgical approach for recurrent macular holes. Am J Ophthalmol Case Rep 2019; 13: 93-95 DOI: 10.1016/j.ajoc.2018.12.014.