Refractory full thickness macular hole: current surgical management.

Area of Science:

• Ophthalmology
• Surgical Techniques
• Retinal Diseases

Background:

• Full-thickness macular holes (FTMH) refractory to initial pars plana vitrectomy and internal limiting membrane (ILM) peeling present a surgical challenge.
• Evaluating alternative surgical strategies is crucial for improving visual outcomes in these complex cases.

Purpose of the Study:

• To systematically review and compare the efficacy of various surgical techniques for treating FTMH resistant to standard vitrectomy and ILM peeling.
• To analyze and contrast the anatomical and functional results of different surgical interventions for refractory FTMH.

Main Methods:

• A comprehensive literature search identified 36 articles detailing surgical techniques for refractory FTMH.
• Articles were categorized by surgical approach, analyzing closure rates and best-corrected visual acuity (BCVA) gain.
• Ten distinct surgical technique subgroups were defined for comparative analysis.

Main Results:

• While refractory FTMH closure rates were similar across all techniques, significant heterogeneity was observed in best-corrected visual acuity (BCVA) gain (p < 0.0001).
• Human amniotic membrane (hAM), lens capsular flap transplantation (LCFT), and autologous platelet concentrate (APC) demonstrated superior BCVA gain.
• Techniques like autologous free ILM flap transplantation and enlargement of ILM peeling showed lower BCVA gains.

Conclusions:

• Human amniotic membrane (hAM) transplantation is the most effective technique for achieving significant visual recovery in refractory FTMH.
• Lens capsular flap transplantation (LCFT) and autologous platelet concentrate (APC) also provide favorable functional outcomes, outperforming free ILM flaps.
• Certain techniques involving extensive retinotomies or grafts offer comparable anatomical and functional results to simpler alternatives, questioning their necessity.