New trends of surgical intervention for refractory macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

LiuJuping ,  LiXiaorong

Tianjin Medical University Hospital, Tianjin Medical University Eye Institute, School of Optometry and Ophthalmology, Tianjin Medical University, Tianjin 300384, China;

Corresponding author：

LiXiaorong, Email: xiaorli@163.com

Keywords：

Retinal perforations/surgery; Vitreoretinal surgery; Review

DOI：

10.3760/cma.j.issn.1005-1015.2016.05.029

Video：

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Abstract Full text Figures/Tables Video References Cited by

Refractory macular hole (MH) has lower surgical anatomical closure rate and poor recovery of visual acuity due to its clinical characteristics. Refractory macular hole includes unclosed MH, reopening MH, large MH, high myopic MH, traumatic MH and secondary MH. Some modified surgeries were employed to improve the surgical results. Inverted internal limiting membrane flap, autologous transplantation of the internal limiting membrane, laser photocoagulation, extended internal limiting membrane peeling, arcuate retinotomy, lens capsular flap transplantation and mesenchymal stem cell transplantation can improve the prognosis partially. Loosening MH traction, providing a scaffold for Müller cell proliferation and promoting photoreceptor reconstruction will be the key points in future.

Citation： LiuJuping, LiXiaorong. New trends of surgical intervention for refractory macular hole. Chinese Journal of Ocular Fundus Diseases, 2016, 32(5): 553-556. doi: 10.3760/cma.j.issn.1005-1015.2016.05.029 Copy

1.	Gass JD. Idiopathic senile macular hole:its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(5):629-639.
2.	Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes:results of a pilot study[J]. Arch Ophthalmol, 1991, 109(5):654-659.
3.	Mahalingam P, Sambhav K. Surgical outcomes of inverted internal limiting membrane flap technique for large macular hole[J]. Indian J Ophthalmol, 2013, 61(10):601-603.DOI:10.4103/0301-4738.121090.
4.	Kang SW, Ahn K, Ham DI. Types of macular hole closure and their clinical implications[J]. Br J Ophthalmol, 2003, 87(8):1015-1019.
5.	Miller JB, Yonekawa Y, Eliott D, et al. A review of traumatic macular hole:diagnosis and treatment[J]. Int Ophthalmol Clin, 2013, 53(4):59-67. DOI:10.1097/ⅡO.0b013e3182a26efe.
6.	Chen SN, Yang CM. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies[J]. Retina, 2015, 36(1):163-170. DOI:10.1097/IAE.0000000000000674.
7.	Fujikawa M, Kawamura H, Kakinoki M, et al. Scleral imbrication combined with vitrectomy and gas tamponade for refractory macular hole retinal detachment associated with high myopia[J]. Retina, 2014, 34(12):2451-2457. DOI:10.1097/IAE.0000000000000246.
8.	Morizane Y, Shiraga F, Kimura S, et al. Autologous transplantation of the internal limiting membrane for refractory macular holes[J]. Am J Ophthalmol, 2014, 157(4):861-869. DOI:10.1016/j.ajo.2013.12.028.
9.	Gekka T, Watanabe A, Ohkuma Y, et al. Pedicle internal limiting membrane transposition flap technique for refractory macular hole[J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(10):1045-1046. DOI:10.3928/23258160-20151027-10.
10.	Kim JY, Kwon OW. Vitrectomy for refractory macular hole[J]. Retin Cases Brief Rep, 2015, 9(4):265-268. DOI:10.1097/ICB.0000000000000183.
11.	Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10):2018-2025.DOI:10.1016/j.ophtha.2010.02.011.
12.	Cho HY, Kim YT, Kang SW. Laser photocoagulation as adjuvant therapy to surgery for large macular holes[J]. Korean J Ophthalmol, 2006, 20(2):93-98. DOI:10.3341/kjo.2006.20.2.93.
13.	Wu DM, Fawzi AA, Recasens MA, et al. Good visual outcome after repair of a very large macular hole with neurosensory retinal operculum[J]. Retin Cases Brief Rep, 2014, 8(2):138-140. DOI:10.1097/ICB.0000000000000025.
14.	Nelson DB, Grantham RL, Marcus DM. Traumatic giant macular hole[J]. Retina, 2001, 21(6):677-678.
15.	Rahman W, Banerjee S. Giant macular hole in Alport syndrome[J]. Can J Ophthalmol, 2007, 42(2):314-315.DOI:10.3129/canjophthalmol.i07-020.
16.	Hillenkamp J, Kraus J, Framme C, et al. Retreatment of full-thickness macular hole:predictive value of optical coherence tomography[J]. Br J Ophthalmol, 2007, 91(11):1445-1449.DOI:10.1136/bjo.2007.115642.
17.	Hernandez-Da Mota SE. Posttraumatic giant macular hole[J]. Case Rep Ophthalmol, 2011, 2(2):283-286. DOI:10.1159/000331114.
18.	Yeshurun I, Guerrero-Naranjo JL, Quiroz-Mercado H. Spontaneous closure of a large traumatic macular hole in a young patient[J]. Am J Ophthalmol, 2002, 134(4):602-603.
19.	Huang J, Liu X, Wu Z, et al. Classification of full-thickness traumatic macular holes by optical coherence tomography[J]. Retina, 2009, 29(3):340-348. DOI:10.1097/IAE.0b013e31819241d0.
20.	Johnson RN, McDonald HR, Lewis H, et al. Traumatic macular hole:observations, pathogenesis, and results of vitrectomy surgery[J]. Ophthalmology, 2001, 108(5):853-857.
21.	Paques M, Massin P, Blain P, et al. Long-term incidence of reopening of macular holes[J]. Ophthalmology, 2000, 107(4):760-765.
22.	Duker JS, Wendel R, Patel AC, et al. Late re-opening of macular holes after initially successful treatment with vitreous surgery[J]. Ophthalmology, 1994, 101(8):1373-1378.
23.	Leonard RE 2nd, Smiddy WE, Flynn HW Jr, et al. Long-term visual outcomes in patients with successful macular hole surgery[J]. Ophthalmology, 1997, 104(10):1648-1652.
24.	Yoshida M, Kishi S. Pathogenesis of macular hole recurrence and its prevention by internal limiting membrane peeling[J]. Retina, 2007, 27(2):169-173. DOI:10.1097/01.iae.0000224940.79223.fb.
25.	Bhatnagar P, Kaiser PK, Smith SD, et al. Reopening of previously closed macular holes after cataract extraction[J]. Am J Ophthalmol, 2007, 144(2):252-259. DOI:10.1016/j.ajo.2007.04.041.
26.	García-Arumí J, Palau MM, Espax AB, et al. Reopening of 2 macular holes after neodymium:YAG capsulotomy[J]. J Cataract Refract Surg, 2006, 32(2):363-366. DOI:10.1016/j.jcrs.2005.07.020.
27.	Haritoglou C, Reiniger IW, Schaumberger M, et al. Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane:update of a prospective study[J]. Retina, 2006, 26(6):618-622. DOI:10.1097/01.iae.0000236474.63819.3a.
28.	Christmas NJ, Smiddy WE, Flynn HW Jr. Reopening of macular holes after initially successful repair[J]. Ophthalmology, 1998, 105(10):1835-1838.
29.	Rahimy E, McCannel CA. Impact of internal limiting membrane peeling on macular hole reopening:a systematic review and meta-analysis[J]. Retina, 2016, 36(4):679-687. DOI:10.1097/IAE.0000000000000782.
30.	Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(3):462-467. DOI:10.1016/j.ajo.2004.09.078.
31.	Wollensak G, Spoerl E, Grosse G, et al. Biomechanical significance of the human internal limiting lamina[J]. Retina, 2006, 26(8):965-968. DOI:10.1097/01.iae.0000250001.45661.95.
32.	Sun CB, Liu Z, Xue AQ, et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye (Lond), 2010, 24(12):1787-1791. DOI:10.1038/eye.2010.123.
33.	Alkabes M, Padilla L, Salinas C, et al. Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(11):2521-2527. DOI:10.1007/s00417-013-2347-y.
34.	Qu J, Zhao M, Jiang Y, et al. Vitrectomy outcomes in eyes with high myopic macular hole without retinal detachment[J]. Retina, 2012, 32(2):275-280. DOI:10.1097/IAE.0b013e31821a8901.
35.	Suda K, Hangai M, Yoshimura N. Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 151(1):118-127. DOI:10.1016/j.ajo.2010.07.007.
36.	Ikuno Y, Tano Y. Vitrectomy for macular holes associated with myopic foveoschisis[J]. Am J Ophthalmol, 2006, 141(4):774-776. DOI:10.1016/j.ajo.2005.11.044.
37.	Li X, Wang W, Tang S, et al. Gas injection versus vitrectomy with gas for treating retinal detachment owing to macular hole in high myopes[J]. Ophthalmology, 2009, 116(6):1182-1187. DOI:10.1016/j.ophtha.2009.01.003.
38.	Lim LS, Tsai A, Wong D, et al. Prognostic factor analysis of vitrectomy for retinal detachment associated with myopic macular holes[J]. Ophthalmology, 2014, 121(1):305-310. DOI:10.1016/j.ophtha.2013.08.033.
39.	Lam RF, Lai WW, Cheung BTO, et al. Pars plana vitrectomy and perfluoropropane (C₃F₈) tamponade for retinal detachment due to myopic macular hole:a prognostic factor analysis[J]. Am J Ophthalmol, 2006, 142(6):938-944. DOI:10.1016/j.ajo.2006.07.056.
40.	Hirano M, Morizane Y, Kawata T, et al. Case report:successful closure of a large macular hole secondary to uveitis using the inverted internal limiting membrane flap technique[J]. BMC Ophthalmol, 2015, 15:83. DOI:10.1186/s12886-015-0072-5.
41.	Michalewska Z, Michalewski J, Dulczewska-Cichecka K, et al. Inverted internal limiting membrane flap technique for surgical repair of myopic macular holes[J]. Retina, 2014, 34(4):664-669. DOI:10.1097/IAE.0000000000000042.
42.	Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1):125-131. DOI:10.1016/j.ajo.2013.02.014.
43.	Shin MK, Park KH, Park SW, et al. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J]. Retina, 2014, 34(9):1905-1910. DOI:10.1097/IAE.0000000000000339.
44.	Imai H, Azumi A. The expansion of RPE Atrophy after the inverted ILM flap technique for a chronic large macular hole[J]. Case Rep Ophthalmol, 2014, 5(1):83-86. DOI:10.1159/000360693.
45.	Ohana E, Blumenkranz MS. Treatment of reopened macular hole after vitrectomy by laser and outpatient fluid-gas exchange[J]. Ophthalmology, 1998, 105(8):1398-1403.
46.	Al Sabti K, Kumar N, Azad RV. Extended internal limiting membrane peeling in the management of unusually large macular holes[J]. Ophthalmic Surg Lasers Imaging, 2009, 40(2):185-187.
47.	Charles S, Randolph JC, Neekhra A, et al. Arcuate retinotomy for the repair of large macular holes[J]. Ophthalmic Surg Lasers Imaging Retina, 2013, 44(1):69-72. DOI:10.3928/23258160-20121221-15.
48.	Lai CC, Wang NK, Chuang LH, et al. Blood clump-assisted vitrectomy and internal limiting membrane peeling for macular hole repair[J]. Retina, 2011, 31(10):2014-2020. DOI:10.1097/IAE.0b013e31821504a5.
49.	Thompson JT, Smiddy WE, Williams GA, et al. Comparison of recombinant transforming growth factor-beta-2 and placebo as an adjunctive agent for macular hole surgery[J]. Ophthalmology, 1998, 105(4):700-706.

1. Gass JD. Idiopathic senile macular hole:its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(5):629-639.
2. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes:results of a pilot study[J]. Arch Ophthalmol, 1991, 109(5):654-659.
3. Mahalingam P, Sambhav K. Surgical outcomes of inverted internal limiting membrane flap technique for large macular hole[J]. Indian J Ophthalmol, 2013, 61(10):601-603.DOI:10.4103/0301-4738.121090.
4. Kang SW, Ahn K, Ham DI. Types of macular hole closure and their clinical implications[J]. Br J Ophthalmol, 2003, 87(8):1015-1019.
5. Miller JB, Yonekawa Y, Eliott D, et al. A review of traumatic macular hole:diagnosis and treatment[J]. Int Ophthalmol Clin, 2013, 53(4):59-67. DOI:10.1097/ⅡO.0b013e3182a26efe.
6. Chen SN, Yang CM. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies[J]. Retina, 2015, 36(1):163-170. DOI:10.1097/IAE.0000000000000674.
7. Fujikawa M, Kawamura H, Kakinoki M, et al. Scleral imbrication combined with vitrectomy and gas tamponade for refractory macular hole retinal detachment associated with high myopia[J]. Retina, 2014, 34(12):2451-2457. DOI:10.1097/IAE.0000000000000246.
8. Morizane Y, Shiraga F, Kimura S, et al. Autologous transplantation of the internal limiting membrane for refractory macular holes[J]. Am J Ophthalmol, 2014, 157(4):861-869. DOI:10.1016/j.ajo.2013.12.028.
9. Gekka T, Watanabe A, Ohkuma Y, et al. Pedicle internal limiting membrane transposition flap technique for refractory macular hole[J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(10):1045-1046. DOI:10.3928/23258160-20151027-10.
10. Kim JY, Kwon OW. Vitrectomy for refractory macular hole[J]. Retin Cases Brief Rep, 2015, 9(4):265-268. DOI:10.1097/ICB.0000000000000183.
11. Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10):2018-2025.DOI:10.1016/j.ophtha.2010.02.011.
12. Cho HY, Kim YT, Kang SW. Laser photocoagulation as adjuvant therapy to surgery for large macular holes[J]. Korean J Ophthalmol, 2006, 20(2):93-98. DOI:10.3341/kjo.2006.20.2.93.
13. Wu DM, Fawzi AA, Recasens MA, et al. Good visual outcome after repair of a very large macular hole with neurosensory retinal operculum[J]. Retin Cases Brief Rep, 2014, 8(2):138-140. DOI:10.1097/ICB.0000000000000025.
14. Nelson DB, Grantham RL, Marcus DM. Traumatic giant macular hole[J]. Retina, 2001, 21(6):677-678.
15. Rahman W, Banerjee S. Giant macular hole in Alport syndrome[J]. Can J Ophthalmol, 2007, 42(2):314-315.DOI:10.3129/canjophthalmol.i07-020.
16. Hillenkamp J, Kraus J, Framme C, et al. Retreatment of full-thickness macular hole:predictive value of optical coherence tomography[J]. Br J Ophthalmol, 2007, 91(11):1445-1449.DOI:10.1136/bjo.2007.115642.
17. Hernandez-Da Mota SE. Posttraumatic giant macular hole[J]. Case Rep Ophthalmol, 2011, 2(2):283-286. DOI:10.1159/000331114.
18. Yeshurun I, Guerrero-Naranjo JL, Quiroz-Mercado H. Spontaneous closure of a large traumatic macular hole in a young patient[J]. Am J Ophthalmol, 2002, 134(4):602-603.
19. Huang J, Liu X, Wu Z, et al. Classification of full-thickness traumatic macular holes by optical coherence tomography[J]. Retina, 2009, 29(3):340-348. DOI:10.1097/IAE.0b013e31819241d0.
20. Johnson RN, McDonald HR, Lewis H, et al. Traumatic macular hole:observations, pathogenesis, and results of vitrectomy surgery[J]. Ophthalmology, 2001, 108(5):853-857.
21. Paques M, Massin P, Blain P, et al. Long-term incidence of reopening of macular holes[J]. Ophthalmology, 2000, 107(4):760-765.
22. Duker JS, Wendel R, Patel AC, et al. Late re-opening of macular holes after initially successful treatment with vitreous surgery[J]. Ophthalmology, 1994, 101(8):1373-1378.
23. Leonard RE 2nd, Smiddy WE, Flynn HW Jr, et al. Long-term visual outcomes in patients with successful macular hole surgery[J]. Ophthalmology, 1997, 104(10):1648-1652.
24. Yoshida M, Kishi S. Pathogenesis of macular hole recurrence and its prevention by internal limiting membrane peeling[J]. Retina, 2007, 27(2):169-173. DOI:10.1097/01.iae.0000224940.79223.fb.
25. Bhatnagar P, Kaiser PK, Smith SD, et al. Reopening of previously closed macular holes after cataract extraction[J]. Am J Ophthalmol, 2007, 144(2):252-259. DOI:10.1016/j.ajo.2007.04.041.
26. García-Arumí J, Palau MM, Espax AB, et al. Reopening of 2 macular holes after neodymium:YAG capsulotomy[J]. J Cataract Refract Surg, 2006, 32(2):363-366. DOI:10.1016/j.jcrs.2005.07.020.
27. Haritoglou C, Reiniger IW, Schaumberger M, et al. Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane:update of a prospective study[J]. Retina, 2006, 26(6):618-622. DOI:10.1097/01.iae.0000236474.63819.3a.
28. Christmas NJ, Smiddy WE, Flynn HW Jr. Reopening of macular holes after initially successful repair[J]. Ophthalmology, 1998, 105(10):1835-1838.
29. Rahimy E, McCannel CA. Impact of internal limiting membrane peeling on macular hole reopening:a systematic review and meta-analysis[J]. Retina, 2016, 36(4):679-687. DOI:10.1097/IAE.0000000000000782.
30. Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(3):462-467. DOI:10.1016/j.ajo.2004.09.078.
31. Wollensak G, Spoerl E, Grosse G, et al. Biomechanical significance of the human internal limiting lamina[J]. Retina, 2006, 26(8):965-968. DOI:10.1097/01.iae.0000250001.45661.95.
32. Sun CB, Liu Z, Xue AQ, et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye (Lond), 2010, 24(12):1787-1791. DOI:10.1038/eye.2010.123.
33. Alkabes M, Padilla L, Salinas C, et al. Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(11):2521-2527. DOI:10.1007/s00417-013-2347-y.
34. Qu J, Zhao M, Jiang Y, et al. Vitrectomy outcomes in eyes with high myopic macular hole without retinal detachment[J]. Retina, 2012, 32(2):275-280. DOI:10.1097/IAE.0b013e31821a8901.
35. Suda K, Hangai M, Yoshimura N. Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 151(1):118-127. DOI:10.1016/j.ajo.2010.07.007.
36. Ikuno Y, Tano Y. Vitrectomy for macular holes associated with myopic foveoschisis[J]. Am J Ophthalmol, 2006, 141(4):774-776. DOI:10.1016/j.ajo.2005.11.044.
37. Li X, Wang W, Tang S, et al. Gas injection versus vitrectomy with gas for treating retinal detachment owing to macular hole in high myopes[J]. Ophthalmology, 2009, 116(6):1182-1187. DOI:10.1016/j.ophtha.2009.01.003.
38. Lim LS, Tsai A, Wong D, et al. Prognostic factor analysis of vitrectomy for retinal detachment associated with myopic macular holes[J]. Ophthalmology, 2014, 121(1):305-310. DOI:10.1016/j.ophtha.2013.08.033.
39. Lam RF, Lai WW, Cheung BTO, et al. Pars plana vitrectomy and perfluoropropane (C₃F₈) tamponade for retinal detachment due to myopic macular hole:a prognostic factor analysis[J]. Am J Ophthalmol, 2006, 142(6):938-944. DOI:10.1016/j.ajo.2006.07.056.
40. Hirano M, Morizane Y, Kawata T, et al. Case report:successful closure of a large macular hole secondary to uveitis using the inverted internal limiting membrane flap technique[J]. BMC Ophthalmol, 2015, 15:83. DOI:10.1186/s12886-015-0072-5.
41. Michalewska Z, Michalewski J, Dulczewska-Cichecka K, et al. Inverted internal limiting membrane flap technique for surgical repair of myopic macular holes[J]. Retina, 2014, 34(4):664-669. DOI:10.1097/IAE.0000000000000042.
42. Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1):125-131. DOI:10.1016/j.ajo.2013.02.014.
43. Shin MK, Park KH, Park SW, et al. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J]. Retina, 2014, 34(9):1905-1910. DOI:10.1097/IAE.0000000000000339.
44. Imai H, Azumi A. The expansion of RPE Atrophy after the inverted ILM flap technique for a chronic large macular hole[J]. Case Rep Ophthalmol, 2014, 5(1):83-86. DOI:10.1159/000360693.
45. Ohana E, Blumenkranz MS. Treatment of reopened macular hole after vitrectomy by laser and outpatient fluid-gas exchange[J]. Ophthalmology, 1998, 105(8):1398-1403.
46. Al Sabti K, Kumar N, Azad RV. Extended internal limiting membrane peeling in the management of unusually large macular holes[J]. Ophthalmic Surg Lasers Imaging, 2009, 40(2):185-187.
47. Charles S, Randolph JC, Neekhra A, et al. Arcuate retinotomy for the repair of large macular holes[J]. Ophthalmic Surg Lasers Imaging Retina, 2013, 44(1):69-72. DOI:10.3928/23258160-20121221-15.
48. Lai CC, Wang NK, Chuang LH, et al. Blood clump-assisted vitrectomy and internal limiting membrane peeling for macular hole repair[J]. Retina, 2011, 31(10):2014-2020. DOI:10.1097/IAE.0b013e31821504a5.
49. Thompson JT, Smiddy WE, Williams GA, et al. Comparison of recombinant transforming growth factor-beta-2 and placebo as an adjunctive agent for macular hole surgery[J]. Ophthalmology, 1998, 105(4):700-706.

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New trends of surgical intervention for refractory macular hole

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