Topical therapy appears effective for closing secondary macular holes

This paper describes the outcomes of secondary full-thickness macular holes (FTMHs) treated with topical therapy.

Study design

This retrospective case series included 123 FTMHs treated between 2016 and 2019. The main outcome measures were closure rate of FTMHs and change in visual acuity.

Outcomes

During the 3-year period, researchers identified 12 eyes with secondary FTMH due to mechanisms other than vitreomacular traction, such as prior vitrectomy, trauma and inflammation. The average initial hole diameter was 79 μm (range 44–132 μm) and all holes had elements of epiretinal membrane and cystoid macular edema (CME).

Nine eyes were treated with topical difluprednate in addition to topical carbonic anhydrase inhibitor (6 eyes) or bromfenac (2 eyes). Eight holes closed (89%) over an average of 6 weeks. Mean vision improved from 20/100 to 20/50. One hole reopened upon cessation of topical therapy and closed once more when the treatment was restarted.

Limitations

This is a small retrospective series and it is unclear how the patients were selected for the topical therapy. Although difluprednate was consistently used, patients received different drop combinations. There was no comparison group, and although there were small macular holes, the rate of spontaneous closure is unknown.

Clinical significance

Secondary FTMH are infrequent but topical therapy should be considered as treatment, particularly when they are small and CME is present. The topical treatment has low morbidity, especially relative to surgical repair.