A Review of Surgical Techniques for the Treatment of Large Idiopathic Macular Holes

Abstract

BACKGROUND AND OBJECTIVE: This meta-analysis reviews available surgical techniques for the repair of macular holes (MHs) >650 μm. MATERIAL AND METHODS: PubMed search criteria were used to identify 17 studies outlining surgical techniques for the repair of MHs >650 μm. Thirteen of the studies identified individual cases and were further analyzed based on MH classification. Success was defined as functional improvement and anatomic closure of the hole. RESULTS: Two hundred and six MHs were included in this study. There were clinically significant differences between the repair of primary and refractory MHs. Autologous retinal transplant resulted in a visual acuity improvement of −0.48 ± 0.36 log-MAR, whereas an inverted internal limiting membrane (ILM) flap and pedicle ILM flap resulted in visual acuity improvements of −0.15 ± 0.17 and −0.14 ± 0.91 logMAR, respectively. CONCLUSION: An inverted or pedicle ILM flap appears more effective for primary MHs, whereas refractory MHs benefit from a free flap. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53:52–61.]