Closure of Macular Holes With Topical Therapy and Why The Hydration Theory of Macular Hole Formation May Be Inaccurate

Purpose: To report the results of a nonsurgical approach to repair macular holes (MHs). Methods: A retrospective chart review of consecutive patients with MHs from 2018 to 2021 was performed. Topical therapy consisted of a steroidal agent, a nonsteroidal agent, and a carbonic anhydrase inhibitor. Data collected included the size, stage, and duration of the MH; topical agents used and the duration; lens status; and complications. Macular edema was graded on a scale ranging from 0 (no edema) to 4 (large amount of edema) and recorded. Before and after MH closure, the best-corrected visual acuity (BCVA) was measured and converted to logMAR notation. Spectral-domain optical coherence tomography was performed. Results: Seven (54%) of the 13 eyes initially treated topically experienced successful MH closure. Small holes (<230 mu m) with a better initial BCVA (0.474 logMAR vs 0.796 logMAR) were more likely to respond favorably to topical therapy (mean 121 mu m vs 499 mu m). In addition, holes with less surrounding edema responded better. All holes not responding to topical therapy were subsequently closed with pars plana vitrectomy, membrane peeling, and fluid-gas exchange. Conclusions: Topical therapy is a reasonable first-line treatment for MHs, with a better than 50% success rate. This is especially true for small early-onset holes with minimal or no edema. Surgery still had a high success rate after a 1- to 3-month delay while the MH was treated with eyedrops.