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Full-Thickness Macular Hole Closure With Topical Medical Therapy
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
To examine the efficacy and clinical characteristics of successful full-thickness macular hole closure with topical therapy.
METHODS
Retrospective case series of full-thickness macular holes managed by a single retinal physician (DS) diagnosed and treated from 2017 to 22.
RESULTS
Of 168 patients with full-thickness macular holes, 71 patients were started on steroid, carbonic anhydrase inhibitor, and nonsteroidal antiinflammatory (NSAID) drops. 49 patients (mean 67 years, 59% women) were included in the analysis, and 22 patients were excluded for poor follow-up. In total, 7/49 were secondary post-PPV holes and 42/49 were idiopathic. In addition, 18/49 eyes (36.7%) achieved closure on topical therapy, of which 13 were idiopathic. Hole size was directly correlated with odds of closure: for every 10 μm decrease in size and odds of closure increased by 1.2× ( P = 0.001, CI 1.1-1.4). Average time to closure was 107.2 days (range 20-512 days) and was not correlated with hole size ( P = 0.217, CI -0.478 to +1.938). The presence of VMT was found to be inversely related to successful closure (OR 6.1, P = 0.029, CI 1.2-31.3). There was no significant difference in final best-corrected visual acuity for eyes undergoing primary pars plana vitrectomy versus those trialing drops before undergoing pars plana vitrectomy ( P = 0.318, CI -0.094 to +0.112).
CONCLUSION
In the first study to date to report the overall efficacy and clinical characteristics of successful macular hole closure with topical therapy, drops achieved an overall closure rate of 36.7%, with higher efficacy in smaller holes and those without VMT. Rates of MH narrowing and reduction in central foveal thickness acted as predictors of effectiveness of drop therapy.
Additional Info
Disclosure statements are available on the authors' profiles:
FULL-THICKNESS MACULAR HOLE CLOSURE WITH TOPICAL MEDICAL THERAPY
Retina (Philadelphia, Pa.) 2024 Mar 01;44(3)392-399, J Wang, SH Rodriguez, J Xiao, W Luo, R Gonnah, L Shaw, D Dao, SA Schechet, AG Mackin, R Komati, D SkondraFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Wang and co-authors reported the results from a retrospective case series study that explored the efficacy and safety of the use of topical drops for full-thickness macular hole (FTMH) closure. The current study, inspired by previous anecdotal reports of medical therapy in patients with FTMH, is the first to propose a combination regimen with topical drops for treating patients with FTMHs, which is normally a surgical indication. The results obtained are encouraging, as the topical drop regimen showed high efficacy for hole closure in these 49 patients with FTMHs, particularly in those with smaller macular holes and without vitreomacular traction (VMT). Therefore, this study provides guidance on how to choose the treatment approach for patients with FTMHs — that is, medical versus surgical — based on the size of the holes and the presence of VMT.
Notably, two issues in data analysis need to be discussed. First, when a total of 49 FTMH cases in this study were classified into idiopathic (42 cases) or secondary post–pars plana vitrectomy (PPV) holes (7 cases), topical drop treatment resulted in a successful hole closure rate of 31% (13/42) in the idiopathic subgroup and 71% (5/7) in the post-PPV subgroup. This difference in successful FTMH closure rate between the subgroups indicates that post-PPV status played a crucial role in FTMH closure, as the previous PPV may have actually minimized the risk of VMT. Second, based on a literature review, the spontaneous FTMH closure rate could be high, reaching up to 22.2%, if the size of idiopathic FTMH is ≤250 µm.1 Meanwhile, based on the current data, the FTMH closure rate after the topical treatment was approximately 28% when the size of the macular hole was between 200 µm and 300 µm (refer to Figure 2 in the article). Therefore, the current data might not have shown a significant difference between the rate of hole closure after topical drop treatment and the spontaneous hole closure rate.
We hope that a controlled study with a large sample size could be pursued to address these unanswered questions.
Reference