Surgical management of macular holes - A report by the American Academy ofOphthalmology

Objective: The document describes macular hole surgery and examines the ava ilable evidence to address questions about the efficacy of the procedure fo r different stages of macular hole, complications during and after surgery, and modifications to the technique. Methods: A literature search conducted for the years 1968 to 2000 retrieved over 400 citations that matched the search criteria. This information was reviewed by panel members and a methodologist, and it was evaluated for the quality of the evidence presented. Results: There are three multicenter, controlled, randomized trials that co nstitute Level I evidence and compare the value of surgery versus observati on for macular hole. There are three multicenter, controlled, randomized tr ials studying the use of adjuvant therapy in macular hole repair. Postopera tive vision of 20/40 or better has been reported in 22% to 49% of patients in randomized trials. The risks of surgical complications include retinal d etachment (3%), endophthalmitis (<1%), cataract (>75%), and late reopening the hole (2% to 10%). Conclusions: The evidence does not support surgery for patients with stage 1 holes. Level I evidence supports surgery for stage 2 holes to prevent pro gression to later stages of the disease and further visual loss. Level I ev idence shows that surgery improves the vision in a majority of patients wit h stage 3 and stage 4 holes. There is no strong evidence that adjuvant ther apy used at the time of surgery results in improved surgical outcomes. Pati ent inconvenience, patient preference, and quality of life issues have not been studied. Ophthalmology 2001;108:1328-1335 (C) 2001 by the American Aca demy of Ophthalmology.