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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Autores principales:	Madi HA, Masri I, Steel DH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Ocriplasmin vitrectomy inner limiting membrane peel posturing tamponade agent expansile gas Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/1ce5bca6533640a290358f80bddf318b
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spelling	oai:doaj.org-article:1ce5bca6533640a290358f80bddf318b2021-12-02T05:10:45ZOptimal management of idiopathic macular holes1177-5483https://doaj.org/article/1ce5bca6533640a290358f80bddf318b2016-01-01T00:00:00Zhttps://www.dovepress.com/optimal-management-of-idiopathic-macular-holes-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Haifa 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 gasMadi HAMasri ISteel DHDove Medical PressarticleOcriplasminvitrectomyinner limiting membrane peelposturingtamponade agentexpansile gasOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2016, Iss Issue 1, Pp 97-116 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ocriplasmin vitrectomy inner limiting membrane peel posturing tamponade agent expansile gas Ophthalmology RE1-994
spellingShingle	Ocriplasmin vitrectomy inner limiting membrane peel posturing tamponade agent expansile gas Ophthalmology RE1-994 Madi HA Masri I Steel DH Optimal management of idiopathic macular holes
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
format	article
author	Madi HA Masri I Steel DH
author_facet	Madi HA Masri I Steel DH
author_sort	Madi HA
title	Optimal management of idiopathic macular holes
title_short	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_sort	optimal management of idiopathic macular holes
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/1ce5bca6533640a290358f80bddf318b
work_keys_str_mv	AT madiha optimalmanagementofidiopathicmacularholes AT masrii optimalmanagementofidiopathicmacularholes AT steeldh optimalmanagementofidiopathicmacularholes
_version_	1718400517482217472

Optimal management of idiopathic macular holes

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