A retrospective review suggests that reasonable anatomic closure and visual improvement may be achieved for full-thickness macular holes associated with macular telangiectasia type 2 (MacTel) using internal limiting membrane (ILM) flaps.
This multicenter, retrospective series evaluated surgical outcomes of various repair techniques for MacTel-associated full thickness macular holes (MTMH), which are a rare but challenging complication of this neurodegenerative condition. A total of 63 surgeries in 47 patients (50 eyes) were analyzed. Techniques utilized included pars plana vitrectomy with ILM peel alone, ILM flap, autologous retinal transplant (ART), retinotomy, and subretinal bleb. The main outcome measures were anatomic closure and visual acuity benefit.
Thirty-four vitrectomies with ILM peel, 22 ILM flaps, 5 ARTs, 1 retinotomy, and 1 subretinal bleb were performed. Overall, closure of MTMHs resulted in improved visual acuity of 2 or more lines in 57% of eyes. The anatomic closure rate was 90% for ILM flaps and 47% for ILM peeling alone, a significant difference; all 5 ARTs were anatomically successful, although visual acuity improvements using this method did not meet statistical significance.
Protocols for each surgical approach were not standardized and involved variations within techniques, which introduces surgical biases. Differences in macular hole size potentially influenced outcome analyses. In addition, the overall sample and the number of cases per technique were small, limiting comparison between surgical strategies and making it difficult to make broad recommendations. Lastly, the chronicity of MTMH presence and the related influence on outcomes could not be assessed.
Full thickness macular holes associated with MacTel are a relatively uncommon and difficult clinical scenario with no current consensus on surgical management. This study offers information regarding possible anatomic closure rates and visual acuity improvement across multiple techniques currently utilized for the treatment of primary, large, and/or refractory macular holes. Based on this data, ILM flaps may be considered a first-line treatment for MTMH, with ART potentially having benefit in refractory cases.
Financial disclosures: Dr. M. Ali Khan discloses financial relationships with Allergan, Apellis Pharmaceuticals, Genentech (Consultant/Advisor); Regeneron Pharmaceuticals (Grant Support).