ABSTRACT
PURPOSE: To describe retinal morphology and vision recovery after spontaneous closure of full-thickness macular hole (FTMH). MATERIALS AND METHODS: Retrospective, observational study. From a database containing 750 FTMH, we included 23 cases. All patients had a complete ophthalmic examination. Swept-source optical coherence tomography angiography was performed. RESULTS: Prior to spontaneous closure in 11 women and 12 men (mean age 67 years), the mean minimum FTMH diameter was 201 µm, and mean base FTMH diameter was 638 µm. Visual acuity improved from 0.29 Snellen to 0.47 Snellen (p = 0.001) after 6 months and showed no further improvement. Spontaneous closure of FTMH was associated with vitreous detachment in less than half of the cases. Irregularities in the deep vascular layer and hyporeflective areas in the choriocapillaris were noted. DISCUSSION: Equal sex distribution of spontaneous closures (1:1) differs from the high prevalence of females seen in the literature. Complete visual recovery is uncommon in cases of spontaneous closure of FTMH. It might be explained by prolonged defects of the choriocapillaris layer. These findings, along with the evolution of the various morphologies reported in the study, could possibly suggest that delaying vitrectomy while hoping for spontaneous closure might not be justified.
Subject(s)
Retinal Perforations , Aged , Female , Humans , Male , Retinal Perforations/diagnosis , Retinal Perforations/surgery , Retrospective Studies , Tomography, Optical Coherence/methods , Visual Acuity , Vitrectomy/methodsSubject(s)
Conjunctiva/blood supply , Retinal Diseases/diagnosis , Sclera/blood supply , Venous Pressure/physiology , Vision Disorders/diagnosis , Water-Electrolyte Imbalance/diagnosis , Adult , Coloring Agents/administration & dosage , Fluorescein Angiography , Humans , Indocyanine Green/administration & dosage , Male , Retinal Diseases/physiopathology , Subretinal Fluid , Tomography, Optical Coherence , Vision Disorders/physiopathology , Visual Acuity/physiology , Water-Electrolyte Imbalance/physiopathologyABSTRACT
Surgical treatment is generally necessary to repair full-thickness macular holes (FTMH). Although vitrectomy with or without internal limiting membrane (ILM) peeling remains the standard surgical technique, the inverted ILM flap procedure has increasingly assumed a role in the primary surgical repair of FTMHs. Some vitreoretinal surgeons reserve this technique to treat large or myopic holes, whereas others use it routinely in all cases. This paper is a comprehensive review of the current scientific evidence on the anatomical and functional outcomes of the inverted ILM flap technique in the repair of macular holes, following the International Vitreomacular Traction Study (IVTS) group classification.
