Published date: Nov 30 2023

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: Oct–Dec 2023, Volume 18, Issue 4

Pages: 424–432

DOI: 10.18502/jovr.v18i4.14555

Ahmad M Mansourammansourmd@gmail.comDepartment of Ophthalmology, American University of Beirut, Beirut, Lebanon

Maurizio ParodiDepartment of Ophthalmology, University Vita-Salute Milan, Milan, Italy

Sami H UwaydatJones Eye Institute, University of Arkansas Medical School, Little Rock, Arkansas, USA

Suzanne CharbajiCharbaji Consultants, Beirut, Lebanon

Javier AscasoDepartment of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

Hana A MansourDepartment of Ophthalmology, American University of Beirut, Beirut, Lebanon

Koushik TripathyASG Eye Hospital, Kolkata, West Bengal, India

Antônio Marcelo Barbante CasellaDepartment of Ophthalmology, Estadual de Londrina, UEL, Londrina, PR, Brasil

Our purpose is to review the closure time and optical coherence tomography (OCT) biomarkers that result in the non-surgical repair of idiopathic full-thickness macular holes (IFTMH). Our methodology consisted of a comprehensive literature review of the nonsurgical resolution of IFTMH followed by the calculation of the estimated closure time using the structural equation model. Forty-nine studies were found eligible yielding 181 eyes with IFTMH: 81.1% being small holes (<250 μm) with a median diameter of 166 μm. Final vision (mean 20/41) was related to initial vision (mean 20/65) and mean age (67 years). The hole diameter was correlated with initial vision and closure time (mean 3.9 months). Closure time was related to hole diameter and initial vision in the following algorithm: Closure time (month)= −0.057 + 0.008 diameter (μm) + 0.021 age (year) + 2.153 initial vision (logMAR). Biomarkers by OCT for self-closure included in decreasing frequency: pointed edge, de-turgescence of cystic macular edema (CME) with reversal of bascule bridge, and vitreomacular traction (VMT) release. The crucial function of Muller cell bridging in sealing the hole attests to its exceptional capacity for regeneration. After the hole has begun to close; however in less than 5%, a delayed restoration of the ellipsoid layer or a persistent outer foveal defect may prevent visual recovery and reopening of the hole is possible. In conclusion, eyes with small-size IFTMH and good baseline vision can have the additional option of close OCT monitoring for biomarkers of self-sealing biomarkers. When rehabilitative activity seems to be lacking, surgery is therefore mandatory.

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