[Resolution of idiopathic macular holes after cryocoagulation of the vitreous base]

There are only few reports on the spontaneous resolution of idiopathic macular holes. We report on 9 cases of resolution of idiopathic macular holes after cryocoagulation of the vitreous base.

We analyzed retrospectively 9 / 201 patients from 2005 - 2007, who were planned for a vitrectomy including peeling of the inner limiting membrane (ILM) due to an idiopathic macular hole. Each patient underwent cryocoagulation of the vitreous base 4 weeks ahead of the planned vitrectomy. At the first visit and the visit after cryocoagulation immediately before PPV was scheduled a complete clinical exam including OCT was performed.

In all 9 cases macular hole had resolved within an average of 30 days after cryocoagulation. In 4 of these patients focal vitreoretinal adherences in the macula were detected in OCT before cryocoagulation was performed. These adhences had resolved after cryocoagulation. In 3 of these patients the posterior vitreous seemed still to adhere even after resolution of the macular hole after cryocoagulation. In 2 of these patients vitreous detachment seemed to have taken place before cryocoagulation as shown in the OCT scans, postoperatively an additional vitreous floater was detected by OCT so that a preoperative posterior vitreoschisis is assumed.

Spontaneous resolution of idiopathic macular holes is very rare. After induction of vitreous detachment by cryocoagulation of the vitreous base, resolution of the macular hole seems to be more frequent. However, we do not recommend to delay vitrectomy due to a macular hole after cryocoagulation.