A delphi consensus study for treatment of full-thickness macular hole in Taiwan

To establish a consensus for surgical management of full-thickness macular hole (FTMH) and macular hole retinal detachment (MHRD). Nine experienced vitreoretinal surgeons from Taiwan participated in questionnaire for surgical management of FTMH and MHRD based on Delphi methodology. Among the 49 items, 30 items (61.2%) reached strong consensus after 2 rounds. For FTMH, strong consensus included routine internal limiting membrane (ILM) peeling in all stages of FTMH, ILM flap in large holes ≥ 400 μm, ILM flap covering technique, small peeling area < 5 mm diameter, preservation of adherent epiretinal membrane in the flap if it cannot be separated from ILM, C₃F₈ as preferred tamponade for ILM peeling alone but not in the presence of ILM flap, post-operative facedown position, simple intravitreal gas injection for early persistent holes, use of pedicle flap or SWIFT for persistent holes in previously small area-peeled macula. For MHRD, strong consensus included the use of ILM flap, ILM flap covering technique, preservation of adherent epiretinal membrane if it cannot be separated from ILM, C₃F₈ as preferred tamponade, post-operative facedown position, no intentional subretinal fluid drainage during air-fluid exchange in small RD area within arcade, intraoperative use of adjuvants. Strong consensus achieved in a significant portion of key questions frequently encountered in the management of FTMH and MHRD. Recommendations from this Delphi study helps in decision-making for clinical practice.