Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2 A Global Multicenter Study

Purpose: To report on macular hole repair in macular telangiectasia type 2 (MacTel2).Design: Global, multicenter, retrospective case series.Participants: Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH).Methods: Standardized data collection sheet distributed to all surgeons.Main Outcome Measures: Anatomic closure and visual outcomes of MTMH.Results: Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 +/- 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 +/- 159.4 mu m (range, 34-573 mu m). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 +/- 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 +/- 0.552 logMAR. MHD was 440.8 +/- 175.5 mu m (range, 97-697 mu m), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 +/- 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 +/- 0.391 logMAR. MHD was 390.2 +/- 203.7 mu m (range, 132-687 mu m). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 +/- 0.246 logMAR (P = 0.08). Visual acuity improved at least 2 lines in 25%.Conclusions: Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs.