Treatment approaches for refractory full-thickness macular holes

Full-thickness macular holes (FTMH) can result in significant visual impairment if untreated. Although conventional treatment achieves high closure rates, FTMH can persist or reopen in some cases. This review examines recent advances in surgical approaches for managing refractory FTMH and highlights their effectiveness and limitations.

Approaches to refractory FTMH aim to relieve traction, encourage glial cell proliferation, improve RPE pump efficiency, increase retinal compliance, and/or provide replacement tissue. A variety of techniques targeting these mechanisms, including various autologous or allogeneic transplants such as internal limiting membrane (ILM) or human amniotic membrane grafts, or surgical manipulations such as macular detachment or relaxing retinotomies, have been proposed. These techniques are reviewed here.

Multiple techniques have shown promise for refractory FTMH. Choice of technique should be guided by characteristics of the FTMH, including size and chronicity, availability of desired tissue or instrumentation, and surgeon familiarity.