Spontaneous resolution of a full-thickness macular hole with good visual acuity

Spontaneous Closure of an Idiopathic Full-Thickness Macular Hole: A Literature Review

Purpose:

This work reviews the literature regarding spontaneous closure of idiopathic full-thickness macular holes (FTMHs).

Methods:

Literature on patients with spontaneous idiopathic FTMH closure was reviewed via Ovid MEDLINE, EMBASE, and PubMed through July 16, 2020. A total of 27 of 66 identified articles were included.

Results:

A total of 68 eyes had spontaneous closure. Of the patients, 62.7% were women and the average age was 67.5 years. Visual acuity improved from Snellen 20/78 to 20/33 post closure. The average hole diameter was 176.8 μm; the largest was 350 μm. Most were stage 2 according to Gass and of small size according to International Vitreomacular Traction Study Group (IVTS) staging. The predominant classification system in recent literature is IVTS staging. The average optical coherence tomography–observed closure time was 4.5 months.

Conclusions:

On review, reported spontaneous closure rates of all idiopathic FTMH range from 3% to 15%, and no demographic subgroups are more likely to have closure. Holes ≤250 µm have higher closure rates (22.2%) than those in the range of >250 to 400 µm (13.3%) and ≥400 µm (0%). Closure is associated with favorable visual outcomes, and retinal bridging via glial cells is likely critical to closure. These determinations were based on limited numbers; prospective studies are needed to further ascertain rate, mechanism, and characteristics. IVTS staging provides reliable reporting and insight into whether FTMH can be observed before surgery.

SPONTANEOUS RESOLUTION OF A STAGE 3 MACULAR HOLE: Long-Term Follow-up With Optical Coherence Tomography

BACKGROUND

While spontaneous resolution of idiopathic macular holes is well documented for early macular holes, spontaneous closure of full-thickness macular holes has been less frequently reported.

METHODS

We followed a case of an idiopathic full-thickness stage III macular hole and its course of spontaneous closure using optical coherence tomography (OCT 3, Carl Zeiss Meditec, CA) over a 2-year period.

RESULTS

OCT scans demonstrated evidence of spontaneous closure of the macular hole over the 2-year follow-up period. Bridging of glial tissue over the macular hole area appeared to occur first with successive scans showing a decrease in the size of the hole. To our knowledge, this is the longest follow-up with OCT in a case of spontaneous resolution of macular holes that has been reported.

CONCLUSION

Recognition of the likelihood of spontaneous closure of macular holes has important clinical values. The advent of OCT technology has provided significant capabilities in the diagnosis and monitoring of macular holes; it has also contributed to the greater understanding of the potential mechanisms involved in spontaneous macular hole closure.

Macular hole

A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Macular holes have been associated with myriad ocular conditions and originally were described in the setting of trauma. The pathogenesis of idiopathic, age-related macular holes remains unclear despite a litany of theories. Recently, Gass has described an updated biomicroscopic classification of macular holes and postulated that tangential vitreous traction may play a role. Cellular components surrounding the rim of macular holes may also contribute tangential traction forces and elevate the rim. Pseudomacular holes may be mistaken for macular hole lesions, despite careful clinical examination. Careful biomicroscopic examination with a contact lens and use of the Watzke and laser aiming beam tests help to ensure accurate diagnosis. Newer imaging technology, such as optical coherence tomography, helps distinguish true macular holes from pseudoholes and may provide additional insight into the pathogenesis of this condition. Surgical management with or without pharmacosurgical adjuncts can improve vision in select cases. The most common surgical complication is progressive lens opacification in phakic patients.