A Review of Surgical Techniques for the Treatment of Large Idiopathic Macular Holes

BACKGROUND AND OBJECTIVE: This meta analysis reviews available surgical techniques for the repair of macular holes (MHs) >650 mu m. MATERIAL AND METHODS: PubMed search criteria were used to identify 17 studies outlining surgical techniques for the repair of MHs >650 mu m. Thirteen of the studies identified individual cases and were further analyzed based on MH classification. Success was defined as functional improvement and anatomic closure of the hole. RESULTS: Two hundred and six MHs were included in this study. There were clinically significant differences between the repair of primary and refractory MHs. Autologous retinal transplant resulted in a visual acuity improvement of -0.48 +/- 0.36 log-MAR, whereas an inverted internal limiting membrane (ILM) flap and pedicle ILM flap resulted in visual acuity improvements of -0.15 +/- 0.17 and -0.14 +/- 0.91 IogMAR, respectively. CONCLUSION: An inverted or pedicle ILM flap appears more effective for primary MHs, whereas refractory MHs benefit from a free flap.