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Customized surgical protocol may simplify macular hole repair

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NEW YORK — Emerging evidence from two separate clinical trials suggests the potential to tailor the surgical protocol for resolution of macular hole to the individual needs of the patient.

Alain Gaudric

Results from the two trials suggest that it may be unnecessary to observe face-down positioning or to peel the internal limiting membrane (ILM) in patients with small macular holes, Alain Gaudric, MD, said here at Retina Congress 2009.

In the first trial, there was no difference in resolution of macular hole in 67 patients with a macular hole less than 400 µm randomized to observe face-down positioning or no positioning.

Anatomic resolution was observed in 94% of patients in the face-down positioning group and in 91% of the no positioning group. However, Dr. Gaudric said, pain was reported more often in patients observing face-down positioning.

In a second trial, which studied the need for ILM peeling in patients with a macular hole greater than or equal to 400 µm, anatomic resolution was observed in 94.9% patients who underwent peeling of the ILM under trypan blue staining compared with 73.2% with no ILM peeling.

"For idiopathic small holes, the success rate is not significantly reduced if face-down positioning is replaced with simply taking care to avoid supine positioning," Dr. Gaudric said. "For large macular holes, the success rate is significantly increased by ILM peeling. Small holes achieve the same closure rate without ILM peeling as larger ones with ILM peeling."