Characteristics and Risk Factors for Spontaneous Closure of Idiopathic Full-Thickness Macular Hole

Liang, Xida; Liu, Wu

doi:10.1155/2019/4793764

Cited by 29 publications

(39 citation statements)

References 33 publications

(31 reference statements)

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“…[44] According to a recent literature review of 58 spontaneously resolved IMHs, the incidence of spontaneous closure is 4-11.5%. [43] MH closure was observed for all stages, though it was less frequent with more advanced stages. Hole diameter was documented in 50 cases.…”

Section: Observation and Spontaneous Closurementioning

confidence: 83%

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Idiopathic macular holes – A review of current management strategies

Sela¹,

Hadayer²,

Zahavi³

2019

cleverjournal

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Description of the Condition Macular holes (MHs) are retinal defects which involve the center of the anatomical fovea. [1,2] Severity may range from asymptomatic incidentally discovered MHs, to advanced vision-threatening ones. [2,3] MHs are often described according to the extent of retinal layers involvement. Full-thickness MHs (FTMHs) encompass all the layers of the retina from the internal limiting membrane (ILM) to the retinal pigmented epithelium (RPE) [Figure 1]. [2] Partialthickness MHs, also termed lamellar holes, involve only the inner retinal layers, while the photoreceptors layer may remain intact [Figure 2]. [2,3] Although the majority of cases are idiopathic (>85%), MHs may also be secondary to various conditions, among the most common of which are high myopia and ocular trauma. [2,4,5] Kumawat et al. described in detail other infrequent causes of secondary MHs. [5] Epidemiology The reported prevalence of idiopathic MHs (IMHs) in the general population ranges between 0.02% and 0.33%. [1,4] IMHs are more common in women (approximately 70% of cases) and usually appear in the 6 th and 7 th decades of life. [1,4,6] For patients with an idiopathic FTMH in one eye, the risk for developing an MH in the fellow eye is 10-20%. [1,7] Pathophysiology IMHs are the sequelae of vitreomacular adhesion (VMA) and traction (VMT). [2] The vitreous is a clear gel-like structure enveloped by a hyaloid membrane (the vitreous cortex), the posterior part of which is attached to the ILM of the retina. With aging, the vitreous body liquefies, shrinks, and gradually detaches from the retina, starting at the posterior pole. Physiologically, the vitreous will continue to detach from the retina and eventually remain firmly attached to the retina only at the vitreous base, straddling the ora serrata. In most cases, this process results in no retinal damage. [2,8,9] However, incomplete or abnormal detachment may result in pathologic VMA and VMT, which can distort the foveal contour and result in MH formation [Figure 3]. [8] The traction forces affect the foveola and might impair central vision, causing distorted vision or decreased visual acuity (VA). [2,5,10]

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Section: Observation and Spontaneous Closurementioning

confidence: 83%

“…Yet, some VMT cases or early FTMHs may spontaneously resolve. [43] Among eyes with VMT, about 60-70% will progress to FTMHs, while the remaining fraction will resolve spontaneously. [44] According to a recent literature review of 58 spontaneously resolved IMHs, the incidence of spontaneous closure is 4-11.5%.…”

Section: Observation and Spontaneous Closurementioning

confidence: 99%

Idiopathic macular holes – A review of current management strategies

Sela¹,

Hadayer²,

Zahavi³

2019

cleverjournal

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“…This is longer than previous studies. [16][17][18][19][20][21][22][23][24][25] It has been reported that the IMHs with disease course more than 6 months is more di cult to close than that of less than 6 months. 11 Therefore, we did a subgroup analysis for those patients with a disease course longer than 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…These parameters are also complex and di cult to calculate, limited their application values in busy real world clinical practice. [16][17][18][19] Based on our clinical experiences 11,20,[23][24][25][26] , we feel that the preoperative MH morphological characteristics are different between postoperative closed and unclosed stage III or IV IMHs. Thus we try to nd a method to quantitatively evaluate the morphological characteristics of preoperative MHs to predict the postoperative closure for stage III or IV IMHs.…”

Section: Introductionmentioning

confidence: 92%

“…Better surgical and functional results are associated with earlier disease stage, better preoperative visual acuity (VA), shorter duration of symptoms, younger patient age, vertical metamorphopsia and the experience of the surgeon. [16][17][18][19][20][21][22][23][24][25][26] With the further understanding of IMH, more factors have been found to predict the closure of IMHs.…”

Section: Introductionmentioning

confidence: 99%

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Hole Diameter Ratio for Prediction of Anatomical Outcomes in Stage III or IV Idiopathic Macular Holes

You

et al. 2020

Preprint

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Purpose: To determine whether preoperative hole diameter ratio (HDR) is a predictive factor for postoperative anatomical outome for stage III or IV idiopathic macular holes (IMHs).Methods: One-hundred and one eyes with stage III or IV IMH were included in this retrospective case series study. All cases were treated with vitrectomy combined with internal limiting membrane (ILM) peeling and room air tamponade. The macular hole (MH) minimum and maximum diameter was measured on preoperative optical coherence tomography (OCT) images. The HDR was defined as the minimum to maximum diameter ratio. Results: Eighty-one eyes (80.2%) got a Type I closure after surgery (group A). Postoperative unclosed MHs were found in 20 eyes (19.8%) (group B). The preoperative minimal diameter (703.6±116.1mm vs. 597.6±120.1mm, P<0.01) and HDR (0.6±0.1 vs. 0.5±0.1, P=0.01) were both significantly smaller in postoperative closed eyes. The closure rate of IMHs with HDR<0.6 was significantly higher than those with HDR³0.6 (90.2% vs. 65.0%P=0.002) .Conclusions: Preoperative HDR<0.6 is predictive for a good postoperative anatomical outcome in stage III or IV IMHs.

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The time course of spontaneous closure of idiopathic full-thickness macular holes

Neubauer,

Gelisken,

Ozturk

et al. 2024

Graefes Arch Clin Exp Ophthalmol

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Purpose Spontaneous closure of idiopathic full-thickness macular holes (iFTMH) has been reported regularly. However, little is known about its probability and timeline. Methods In this retrospective study all consecutive patients who presented between August 2008 and August 2019 were screened for the presence of a macular hole and only iFTMHs were included. The primary outcome measure was the spontaneous closure of the iFTMH. Results Of 1256 eyes with macular holes, 338 fulfilled the inclusion criteria. Spontaneous closure of the iFTMH was detected in 31 eyes (9.2%) with a median time of 44 days after diagnosis. Eyes exhibiting spontaneous closure demonstrated a higher baseline best-corrected visual-acuity (BCVA) and smaller iFTMH diameter (p < 0.0001 and p < 0.0001, respectively). The mean BCVA improved from 0.4 logMAR (SD ± 0.21) to 0.29 logMAR (SD ± 0.20) after spontaneous closure (p = 0.031). The iFTMH diameter was positively correlated with the time to spontaneous closure (Pearson-r = 0.37, p = 0.0377). Spontaneously closed iFTMHs reopened in 16% (n = 5) of cases, with a median of 136 days after closure. A logistic regression model showed the hole diameter was associated with spontaneous closure (odds-Ratio 0.97, 95%CI [0.96, 0.98]). The Kaplan–Meier-Curve revealed that approximately 25% of small-iFTMH (n = 124) and 55% of iFTMH with a diameter < 150µm (n = 48) closed spontaneously within two months. Conclusion The established gold-standard for the treatment of iFTMHs is macular surgery. However, the potential for spontaneous closure of small iFTMHs must be acknowledged. Therefore, if surgical treatment is delayed in individual cases, close observation is recommended.

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Characteristics and Risk Factors for Spontaneous Closure of Idiopathic Full-Thickness Macular Hole

Cited by 29 publications

References 33 publications

Idiopathic macular holes – A review of current management strategies

Idiopathic macular holes – A review of current management strategies

Hole Diameter Ratio for Prediction of Anatomical Outcomes in Stage III or IV Idiopathic Macular Holes

The time course of spontaneous closure of idiopathic full-thickness macular holes

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