Persistent Macular Hole Management Options

Abstract

The widely accepted gold standard technique for the treatment of Macular holes is pars plana vitrectomy combined with internal limiting membrane peeling, resulting in closure rates of 80–100%. Results are influenced by the base diameter, inner opening size, and chronicity, with outcomes less favorable for larger holes and those persisting for over a year. In recent years, surgical attention has shifted toward addressing the closure of refractory or very large holes. Literature has published significant data showing satisfactory anatomical and promising visual outcomes. These techniques can be categorized based on the presumed mechanisms of closure induction. Retinal expansion, autologous retinal transplant, ILM flaps, lens capsules, or amniotic membranes within the MH, each yielding varying closure rates. Modulation of intraretinal gliosis through growth and neurotrophic factors using autologous blood-derived plugs or scaffolds to facilitate Muller cell migration and proliferation have also been documented. Plasma rich in growth factors (PRGF) exhibits anti-inflammatory, anti-fibrotic, and regenerative functions lead to high MH closure rates, garnering attention from retinal surgeons globally. The growing volume of publications suggests benefits from Plasma Rich in Growth Factors over other plasma derivatives. While there is no definitive method for treating macular holes, these newer techniques offer a promising future.