Idiopathic Macular Hole
HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE
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. (, , )
Idiopathic Macular Hole
February 1, 2020
Last Updated Month/Year
July 28, 2023
Supplemental Implementation Tools
External Publication Status
Country of Publication
Identify patients at risk for macular hole. Educate high-risk patients about the reason for periodic monocular self-assessment and follow-up examination, the symptoms of a macular hole, and the need to return promptly should symptoms occur. Follow patients who are at risk for vision loss from macular hole. Inform patients of the risks and benefits of the treatment options for macular hole. Optimize recovery of visual function.
Target Patient Population
Patients 55 years of age or older
Health Care Settings
Emergency care, Hospital, Outpatient
Optometrist, nurse, nurse practitioner, physician, physician assistant
Diagnosis, Management, Treatment
D008268 - Macular Degeneration, D008269 - Macular Edema, D005128 - Eye Diseases
macular hole, macular disease, eye disease
Flaxel, C. J., Adelman, R. A., Bailey, S. T., Fawzi, A., Lim, J. I., Vemulakonda, G. A., & Ying, G. (2019). Idiopathic Macular Hole Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.026