Macular hole surgery in 2000.

Patient selection and surgical experience have increased the closure rates for idiopathic macular holes to more than 90%. The best surgical results are obtained in patients with acute idiopathic macular holes. Biologic adjuvants are not as useful as they were once thought to be. Internal limiting membrane peeling and endolaser are useful for failed macular holes, reopened macular holes, and chronic macular holes. Internal limiting membrane peeling may not be necessary for acute idiopathic macular holes, provided a complete posterior vitreous detachment is created. Silicone oil tamponade should be considered in patients who have positioning problems or air travel plans. Humidifying the infusion air may reduce postoperative visual field defects. Every patient with a macular hole should be given the opportunity to improve his or her vision with macular hole surgery.