Idiopathic Macular Hole PPP 2019

By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee: Christina J. Flaxel, MD,¹ G. Atma Vemulakonda, MD,² Ron A. Adelman, MD, MPH, MBA, FACS,³ Steven T. Bailey, MD,⁴ Amani Fawzi, MD,⁵ Jennifer I. Lim, MD,⁶ Gui-shuang Ying, MD, PhD⁷

As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the journal's PPP collection page.

¹Casey Eye Institute, Oregon Health & Science University, Portland, OR

²Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA

³Yale University Eye Center, New Haven, CT

⁴Casey Eye Institute, Oregon Health & Science University, Portland, OR

⁵Feinberg School of Medicine, Northwestern University, Chicago, IL 

⁶University of Illinois at Chicago, Chicago, IL

⁷Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Highlighted Findings and Recommendations for Care

Macular holes are more common in females than in males and usually occur after age 55. There is a high rate of macular hole formation in the fellow eye (10%-15%) in the 5-year period after a macular hole occurs in the first eye.

Patients with vitreous traction and no macular hole (stage 1-A or 1-B) should be observed without treatment, because they often remain stable or even improve. Currently, there is no evidence that treatment improves the prognosis.

Most patients with stage 2 to 4 macular holes will have a poor prognosis without treatment. The visual prognosis is good following successful macular hole closure. The benefits of treatment designed to achieve macular hole closure should be discussed.

Studies report that approximately 90% of recent macular holes that are <400 µm can be closed with vitrectomy surgery.

The early detection of a macular hole is associated with both a higher closure rate after vitrectomy surgery as well as better postoperative visual acuity.

Careful removal of the internal limiting membrane (ILM) during vitrectomy surgery increases the macular hole closure rate without adversely affecting the visual acuity

Cataract is a frequent complication of vitrectomy surgery to repair macular holes. This risk should be discussed with patients preoperatively, and postoperative monitoring is advised.

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