Visual Outcomes after Spontaneous and Surgical Closure of Small Idiopathic Macular Holes: A Comparative Study

Small full-thickness macular holes (FTMHs) are classically treated surgically but can also occasionally close spontaneously. Long-term visual outcomes of spontaneously closed FTMHs are not well described. We compared best-corrected visual acuity (BCVA) after surgical and spontaneous closure of idiopathic FTMH (IMHs) and assessed the effect of IMH size on BCVA.

This retrospective study was performed at Rothschild Foundation Hospital, Paris, France, from January 2015 to June 2021. The study included patients with small IMH, i.e., ≤250 μm, divided into spontaneously closed IMH (SIMH) and surgically closed IMH. Both groups were divided into 3 subgroups according to IMH diameter: <100 μm, 100-150 μm, or 151-200 μm.

A total of 109 patients had surgical IMH closure and 18 spontaneous IMH closure. Among all the patients of the study, we observed 17% of spontaneous closure. All SIMHs were <250 μm. The groups did not differ in final BCVA or BCVA gain. BCVA significantly improved after surgery whatever the IMH size. In the SIMH group, final BCVA did not differ by IMH size. In the 100-150 μm subgroups, BCVA gain was significantly greater for the surgical closure compared to the SIMH groups (-0.35 ± 0.2 vs. -0.16 ± 0.2 logMAR; p = 0.01).

Vision results are similar between spontaneously closed and surgically closed macular holes. Spontaneous closure of macular holes can occur; it is therefore reasonable to consider observation before macular hole surgery.