Clinical Treatment of Refractory Full Thickness Macular Hole (FTMH)
A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".
Deadline for manuscript submissions: 24 July 2025 | Viewed by 430
Special Issue Editor
Special Issue Information
Dear Colleagues,
Pars plana vitrectomy (PPV), epiretinal membrane (ERM) peeling and gas tamponade have been proposed by some scholars for treating primary full thickness macular hole (FTMH). They reported closure rates superior to 50%. Improving vitreoretinal surgical techniques, understanding pathological mechanisms of FTMH better and introducing intraoperative adjuvant agents allows surgeons to obtain better results, exceeding 90% FTMH closure rates. The greatest advancement in FTMH surgery was reached with the introduction of internal limiting membrane (ILM) peeling. Currently, PPV with ILM peeling is the gold standard treatment for FTMH. Despite the macular hole closure rate being very high, a refractory FTMH may occur.
Refractory FTMH is a generic definition that includes both a “reopened FTMH”, an FTMH occurring after surgically induced closure, and “unclosed or persistent FTMH”, an FTMH that does not close at the end of surgery.
A FTMH refractory to PPV and ILM peeling is a challenge for surgeons, and several of the proposed surgical techniques have been studied in the ongoing search for the best treatment. An enlargement of ILM peeling demonstrated that ILM has to be removed up to the vascular arcades. Light silicone oil (SO), heavy SO and blood derivatives (as whole blood (WB) or autologous platelet concentrate (APC)) have been widely used, alone or combined with other procedures.
Some scholars proposed to place an autologous tissue graft into or over a FTMH, such as autologous free ILM flap transplantation (free ILM flap), lens capsular flap (LCF) harvested from the anterior or posterior capsule, autologous retinal graft (ARG), and human amniotic membrane (hAM). The rationale for using one of these tissue grafts is based on their potential induction of cell proliferation, potential role as a scaffold for the subsequent regeneration of the retinal layers (ILM, LCF and hAM) or even ARG and potential functional activation by contact with the retinal pigment epithelium (RPE) or the edges of FTMH. Using the originally proposed surgical techniques, different surgical variants have been implemented via the use of adjuvant agents for facilitating the positioning of the tissue graft and reducing the risk of postoperative graft dislodgement. Surgical techniques that are completely different from the previously cited perifoveal relaxing retinotomy, arcuate temporal retinotomy and macular hole hydrodissection (MHH) techniques are worthy of stand-alone status. These techniques are based on the rationale of making the retina more elastic for inducing FTMH closure.
This Special Issue will collect research on the surgical techniques currently in use for the treatment of refractory FTMH and provide information on the surgical variants, the results obtained and the complications to better understand which is the best and most standardizable approach for this macular pathology.
Dr. Rino Frisina
Guest Editor
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Keywords
- refractory full thickness macular hole
- pars plana vittectomy
- internal limiting membrane
- peeling
- tamponade
- flap
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