Vitreous Surgery for Idiopathic Macular Holes

Idiopathic macular holes are generally considered an untreatable condition. We used modern vitrectomy techniques to evaluate two questions: (1) Is it possible to reattach the retina around the macular hole? (2) If it is reattached, will the patient's central vision improve? In 30 (58%) of 52 patients, we were able to reattach successfully the detached macula with our surgical procedure. In 22 (73%) of the 30 patients in whom the macula was successfully reattached, there was an improvement in visual acuity of two lines or better. In the 22 patients in whom reattachment of the macular hole was not obtained, there was no significant improvement in visual acuity. Thus, the overall success rate for improved vision postoperatively was 42% (22/52). Complications related to surgery were observed in eight patients (15%) early in our experience with this procedure and included increase in the size of the macular hole, mottling of the retinal pigmented epithelium, and a vascular occlusion. Our clinical observations indicate that the treatment of macular holes by vitrectomy may offer some promise for this otherwise untreatable condition. In patients in whom reattachment was successful, the technique used appeared to allow for clinically significant improvements in visual acuity. However, additional work on increasing surgical success and minimizing surgical complications, as well as a further understanding of the mechanism of retinal reattachment, is required before widespread use of this procedure for treating macular holes.