Surgical management of idiopathic macular holes

Idiopathic macular holes have long been considered to be a stable, untreatable condition with little or no chance of spontaneous visual improvement. Within the last few years, surgical intervention has been developed for the management of idiopathic Stage 3 and Stage 4 holes. With pars plana vitrectomy surgery, at least 50% of patients will experience a 2 or more line improvement in visual acuity, and 25% of patients will improve to 20/40 or better. Since the natural history of idiopathic macular holes is extremely poor, all patients with Stage 3 or 4 lesions should be seriously considered for vitreous surgery.