Secondary macular holes: when to jump in and when to stay out

Comparative Study between Pars Plana Vitrectomy with Internal Limiting Membrane Peel and Pars Plana Vitrectomy with Internal Limiting Membrane Flap Technique for Management of Traumatic Full Thickness Macular Holes

“…Secondly, it induced shearing of the Müller cells' foot plates thereby triggering glial cells proliferation along the interface created by the gas bubble, eventually inducing closure of the hole [11]. While this scenario applied to primary FTMH that were caused by anomalous vitreofoveolar traction, similar success was not achieved in FTMH secondary to trauma [12, 13]. The pathogenic mechanisms entailed in traumatic FTMH formation included direct injury from blunt trauma inducing the classic trampoline effect or from open globe injury, and indirect injury from a propagating shock wave of chorioretinitis sclopetaria or pressure necrosis of the foveal area by subfoveal hemorrhage [14–17].…”

<p>Optical Coherence Tomography Morphological Features Following Modified Internal Limiting Membrane Surgical Technique In Traumatic Macular Holes</p>

“…Delayed TMH formation could develop subsequent to tissue degeneration following commotio-retina 2–6. The visual outcome of surgery is even aggravated by several co-morbidities inherent to the inciting trauma, including frequent large hole size, associated atrophy of the retinal pigment epithelium (RPE), sub-retinal hemorrhage or choroidal rupture 7. A reasonable surgical approach for TMH would be a technique that combines stimulus for glial cell proliferation to close the full-thickness defect while avoiding inflicting further damage to the RPE at the base of the hole that is already compromised by trauma 8.…”

Surgical outcome of full-thickness macular hole secondary to tractional retinal detachment in proliferative diabetic retinopathy

“…However, the clinical characteristics and surgical outcomes of secondary FTMH are different. [ 4 9 15 16 17 ] MH in eyes with PDR TRD is formed due to perimacular tangential traction exerted by the FVP(s). As a result, detachment around the MH is usually larger than the simple cuff seen in the idiopathic FTMH.…”

“…[ 2 3 ] MH in these eyes occurs secondary to the traction produced by active fibrovascular proliferation (FVP) on the foveal edges, which are already weakened by edema and ischemia. [ 4 ]…”

“…[ 3 7 8 9 10 ] Some authors even suggest conservative management for eyes with FTMH and macula attached TRD as the results are not very encouraging. [ 2 3 4 7 8 ] Another controversy related to the management of such eyes is the role of internal limiting membrane (ILM) peeling. [ 2 8 11 12 ]…”