Delayed Spontaneous Closure of Macular Holes after Failed Surgery: A Scoping Review of Clinical Outcomes and...

Review the phenomenon of delayed and spontaneous closure of full-thickness macular holes (FTMHs) following apparent primary surgical failure and to synthesize reported timelines, visual outcomes, and proposed mechanisms.

A scoping review was conducted using PubMed and Embase (January 1990-June 2024). Case reports, case series, and observational studies were eligible if they described MH that remained open after surgery but subsequently closed spontaneously. Data on baseline characteristics, surgical technique, postoperative features, time to closure, and visual outcomes were extracted. Fifteen studies met inclusion criteria, of which 13 provided patient-level data. Across all cases, the mean time to closure was 536 days (median 150, IQR 90-480, range 27-2555), although this distribution was skewed by rare very late closures up to 7 years. Excluding cases closing beyond 1 year, the mean time to closure was 124 days (median 120, IQR 70-150, range 27-270), indicating that most delayed closures occur within 3-6 months. Visual acuity (VA) showed a mean improvement of -0.32 logMAR (median -0.35, IQR -0.50 to -0.15, range -1.10 to +0.80). Restricting to cases closing within 1 year yielded a mean improvement of -0.35 logMAR (median -0.50, IQR -0.65 to -0.20), corresponding to approximately three to four lines of VA gain.

Delayed spontaneous closure of FTMHs after apparent primary surgical failure is uncommon but clinically relevant. It has most often been observed within the first 6-12 months and is frequently accompanied by some VA improvement, although outcomes vary widely.