Optimal management of idiopathic macular holes
Haifa A Madi,1,* Ibrahim Masri,1,* David H Steel1,2 1Sunderland Eye Infirmary, Sunderland, 2Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle, UK *These authors contributed equally to this work Abstract: This review evaluates the current surgical option...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2016-01-01
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| Series: | Clinical Ophthalmology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/optimal-management-of-idiopathic-macular-holes-peer-reviewed-article-OPTH |
| _version_ | 1818744009657417728 |
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| author | Madi HA Masri I Steel DH |
| author_facet | Madi HA Masri I Steel DH |
| author_sort | Madi HA |
| collection | DOAJ |
| description | Haifa A Madi,1,* Ibrahim Masri,1,* David H Steel1,2 1Sunderland Eye Infirmary, Sunderland, 2Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle, UK *These authors contributed equally to this work Abstract: This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use. Keywords: ocriplasmin, vitrectomy, inner limiting membrane peel, posturing, tamponade agent, expansile gas |
| first_indexed | 2024-12-18T02:37:30Z |
| format | Article |
| id | doaj.art-1ce5bca6533640a290358f80bddf318b |
| institution | Directory Open Access Journal |
| issn | 1177-5483 |
| language | English |
| last_indexed | 2024-12-18T02:37:30Z |
| publishDate | 2016-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Ophthalmology |
| spelling | doaj.art-1ce5bca6533640a290358f80bddf318b2022-12-21T21:23:45ZengDove Medical PressClinical Ophthalmology1177-54832016-01-012016Issue 19711625224Optimal management of idiopathic macular holesMadi HAMasri ISteel DHHaifa A Madi,1,* Ibrahim Masri,1,* David H Steel1,2 1Sunderland Eye Infirmary, Sunderland, 2Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle, UK *These authors contributed equally to this work Abstract: This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use. Keywords: ocriplasmin, vitrectomy, inner limiting membrane peel, posturing, tamponade agent, expansile gashttps://www.dovepress.com/optimal-management-of-idiopathic-macular-holes-peer-reviewed-article-OPTHOcriplasminvitrectomyinner limiting membrane peelposturingtamponade agentexpansile gas |
| spellingShingle | Madi HA Masri I Steel DH Optimal management of idiopathic macular holes Clinical Ophthalmology Ocriplasmin vitrectomy inner limiting membrane peel posturing tamponade agent expansile gas |
| title | Optimal management of idiopathic macular holes |
| title_full | Optimal management of idiopathic macular holes |
| title_fullStr | Optimal management of idiopathic macular holes |
| title_full_unstemmed | Optimal management of idiopathic macular holes |
| title_short | Optimal management of idiopathic macular holes |
| title_sort | optimal management of idiopathic macular holes |
| topic | Ocriplasmin vitrectomy inner limiting membrane peel posturing tamponade agent expansile gas |
| url | https://www.dovepress.com/optimal-management-of-idiopathic-macular-holes-peer-reviewed-article-OPTH |
| work_keys_str_mv | AT madiha optimalmanagementofidiopathicmacularholes AT masrii optimalmanagementofidiopathicmacularholes AT steeldh optimalmanagementofidiopathicmacularholes |