Surgical Options for Refractory Macular Holes [Video]

By Sumit Sharma, MD

Judging by the discussion at retina conferences, you might get the impression that there’s an epidemic of nonclosing macular holes. However, the closure rate of macular holes is actually very good.

Some macular holes close spontaneously (4%-11.5%) — especially when they’re smaller than 250 microns. According to a 2019 meta-analysis, up to one in 10 of these smaller holes can close on their own. They are more likely to close if they have a bridging membrane and when any remaining traction is released.

In addition, the closure rate of macular holes after internal limiting membrane (ILM) peeling is 90%-97%. At Cleveland Clinic Cole Eye Institute, the closure rate is closer to 98%.

Primary repair: ILM peeling

An ILM peel with gas …