Idiopathic Macular Hole: Algorithm for Nonsurgical Closure Based on Literature Review.

Area of Science:

• Ophthalmology
• Regenerative Medicine
• Medical Imaging

Background:

• Idiopathic full-thickness macular holes (IFTMH) are a significant cause of vision impairment.
• Non-surgical management options are increasingly explored for IFTMH.
• Predicting spontaneous closure and visual outcomes remains a clinical challenge.

Purpose of the Study:

• To review closure time and optical coherence tomography (OCT) biomarkers associated with non-surgical repair of IFTMH.
• To estimate closure time using a structural equation model based on existing literature.
• To identify key indicators for successful spontaneous resolution of IFTMH.

Main Methods:

• Comprehensive literature review of nonsurgical resolution of IFTMH.
• Calculation of estimated closure time using a structural equation model.
• Analysis of 49 eligible studies involving 181 eyes with IFTMH.

Main Results:

• Small holes (<250 µm) were predominant (81.1%), with a median diameter of 166 µm.
• Final vision (mean 20/41) correlated with initial vision (mean 20/65) and age (67 years).
• Closure time (mean 3.9 months) was predicted by hole diameter, age, and initial vision (logMAR).
• Key OCT biomarkers for self-closure included pointed edge, de-turgescence of cystic macular edema (CME), and vitreomacular traction (VMT) release.
• Muller cell bridging is crucial for hole sealing, demonstrating regenerative capacity.

Conclusions:

• Eyes with small IFTMH and good baseline vision may benefit from close OCT monitoring for self-sealing biomarkers.
• Delayed restoration of the ellipsoid layer or persistent outer foveal defects can impede visual recovery.
• Surgical intervention is mandatory when spontaneous closure or visual recovery appears unlikely.