Related Experiment Video
Updated: Apr 19, 2026
Retinal Pigment Epithelium Transplantation in a Non-human Primate Model for Degenerative Retinal Diseases
Published on: June 14, 2021
Pediatric Macular Hole Outcomes with Surgical and Nonsurgical Management: An IRIS® Registry Study
David C Holden1, Tutut N Sudiran1, Lomas S Persad1
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Insights
Pediatric macular hole (PMH) surgery leads to rapid visual gains with low complications, while observation also shows improvement. These findings support personalized PMH treatment based on severity and risks.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Retinal Surgery
Background:
- Pediatric macular hole (PMH) management requires understanding visual outcomes and complication risks.
- Surgical versus observational approaches for PMH have not been extensively compared in large pediatric cohorts.
Purpose of the Study:
- To compare visual outcomes, recovery trajectories, and complication rates between surgical and observational management of pediatric macular hole (PMH).
- To identify predictors of surgical intervention in pediatric macular hole cases.
Main Methods:
- Retrospective cohort study of children (<18 years) diagnosed with PMH using the American Academy of Ophthalmology IRIS® Registry (2013-2024).
- Eyes were categorized as surgical (pars plana vitrectomy) or observational.
- Longitudinal best-corrected visual acuity (BCVA) was assessed for up to 2 years; generalized estimating equations and mixed-effects logistic regression were used.
Main Results:
- 1,261 patients (1,390 eyes) were analyzed; 20.1% underwent surgery.
- Surgical eyes had worse baseline BCVA but showed greater improvement (-0.40 logMAR) and faster recovery (0.75 years) compared to observational eyes (-0.12 logMAR, 1.30 years).
- Surgical complications were low (83.5% no complications); worse baseline BCVA predicted surgery.
Conclusions:
- Surgical repair of pediatric macular holes offers rapid, sustained visual improvement with a low complication profile.
- Observational management can also lead to significant spontaneous visual recovery.
- An individualized approach to PMH management is recommended, considering baseline severity, visual status, and surgical risks.
Purpose:
To compare visual outcomes, recovery trajectories, and complication rates between surgical and observational management of pediatric macular hole (MH) using a large national registry.
Design:
Retrospective cohort study.
Subjects:
Children younger than 18 years diagnosed with MH-related pathology between January 2013 and October 2024 in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight), with a minimum of 6 months of follow-up.
Methods:
Eyes were categorized as surgical if they underwent pars plana vitrectomy with or without internal limiting membrane or epiretinal membrane peeling, or observational if managed without surgery. Best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution) was assessed longitudinally for up to 2 years. Visual acuity trajectories were modeled using generalized estimating equations, and multivariable mixed-effects logistic regression was used to identify predictors of surgical intervention.
Main Outcome Measures:
Longitudinal BCVA, time to maximal BCVA, magnitude of visual acuity improvement, postoperative complications, and predictors of surgical management.
Results:
A total of 1261 patients (1390 eyes; median age, 14 years; 62% male) were included; 254 patients (20.1%) underwent surgery, and 1007 (79.9%) were observed. Surgical eyes presented with worse baseline BCVA than observed eyes (median, 0.80 vs. 0.40 logarithm of the minimum angle of resolution; P < 0.001). Both cohorts demonstrated significant visual improvement over time (P < 0.001), with parallel improvement trajectories. Surgical eyes achieved greater median improvement from baseline to maximal BCVA (-0.40 vs. -0.12 logarithm of the minimum angle of resolution; P < 0.001) and reached maximal vision sooner (median, 0.75 vs. 1.30 years; P < 0.001). Among surgical eyes, 83.5% experienced no postoperative complications; repeat MH surgery occurred in 10.6%, cataract surgery in 4.3%, retinal detachment repair in 1.6%, and no cases of endophthalmitis were observed. Worse baseline visual acuity was the only independent predictor of surgical intervention.
Conclusions:
In this large registry-based study of pediatric MH management, surgical repair was associated with rapid, sustained, and clinically meaningful visual improvement with low complication rates. Nonsurgical management also yielded spontaneous clinically significant visual improvement. These findings support an individualized approach to pediatric MH management that takes into consideration baseline anatomic and visual severity, recovery trajectory, and surgical risk.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Related Concept Videos
01:28Angle Closure Glaucoma: Treatment
01:27Open Angle Glaucoma: Treatment
Drugs such as carbonic anhydrase inhibitors, α2- and...