A retrospective, multicenter study on the management of macular holes without residual internal limiting membrane: the refractory macular hole (ReMaHo) study

Abstract

Purpose To evaluate the surgical management, outcomes and prognostic factors of full thickness macular holes without residual internal limiting membrane (NO-ILM FTMHs). Methods We performed a multicenter, retrospective study of 116 NO-ILM FTMHs. Human amniotic membrane (hAM) plug, autologous ILM free flap transplantation (AILMT), and autologous retinal graft transplantation (ART) were performed in 58, 48, and 10 patients, respectively. Data were collected before and up to 12 months after surgery. The primary outcomes were hole closure and final best-corrected visual acuity (BCVA). Results The final BCVA (0.78 ± 0.51 logMAR) was significantly better than and correlated with the initial BCVA (p < 0.0001 and p = 0.004, respectively). Hole closure was achieved in 92% of eyes. The minimum FTMH diameter was wider and final BCVA was lower in the ART group than in the other groups (p < 0.003 and p < 0.001, respectively). FTMHs with diameter > 680 μm had a higher closure rate with hAM than with AILMT (p = 0.02). Conclusions AILMT and hAM were the most frequently performed surgeries with both high closure rate and significant functional improvement. Preoperative BCVA was correlated with final BCVA. The minimum FTMH diameter may guide the treatment choice.

Enhancing inverted internal limiting membrane flap stability in macular hole retinal detachment by the “viscoelastic agent pool” technique

“…Some studies have reported that BCVA with MHRD after surgery was related to preoperative visual acuity. 17,18 We found that BCVA improvement after MH sealing was not associated with corrected MH diameter, axial length, age, or sex. We attributed our results to the following point: patients with MHRD had atrophic myopic maculopathy in different scales, retinal choroidal and outer retinal layer atrophy should be considered when evaluating the postoperative vision recovery.…”

Sealed Unilateral Full-Thickness Macular Hole with Amniotic Membrane Graft in a Patient with Alport Syndrome: A Case Report

“…Successful closure of large, refractory, or recurrent MH where ILM is missing has been achieved with the use of AM grafts [15]. Because the AM graft should be placed under the edges of the MH, with the chorion/stromal side facing the RPEs, careful placement of AM can be challenging [16][17][18][19][20]. Table 1 summarizes the previous studies on the surgical management of MH in Alport patients.…”

Persistent Macular Hole Management Options

“…Some FTMHs remain open after primary surgery (refractory), or they reopen after initial closure (recurrent), necessitating secondary surgery. Secondary closure proves successful in over 75% of patients, not often leading to substantial visual improvement [27].…”