Macular holes.

Spontaneous closure of macular holes occurs in 3% to 9% of patients over 6 years [3,58]. Visual acuity can recover dramatically once the hole closes. The risk for hole development in the fellow eye in the absence of PVD is approximately 29%. The presence of vitreomacular separation reduces the risk to less than 5%. Most of the fellow eyes that develop macular holes do so within 2 years [59]. Macular hole surgery has been evolving. ILM peeling is a recent, widely accepted innovation. Meta-analysis of 12 published case series indicates anatomic success in 77% and functional success in 55% of patients with the traditional technique of epiretinal peeling and no adjuvant use. Meta-analysis of 22 series with techniques using adjuvants indicates an anatomic success rate of 81% and a functional success rate of 60%. Meta-analysis of 4 studies involving 221 cases indicates an anatomic success rate of 96% and a functional success rate of 81% [5]. True superiority of one approach versus another cannot be determined without a randomized, prospective clinical trial, which is unlikely to be conducted. In the meantime, surgeons must choose an approach based on individual features of a given patient and their own surgical experience.