Spontaneous Closure of Idiopathic Full-Thickness Macular Holes Associated With Favorable Visual Outcomes

Spontaneous closure of an idiopathic full-thickness macular hole (FTMH) is associated with a favorable visual prognosis, while retinal bridging via glial cells is likely crucial to experience closure, according to a study published in the Journal of VitreoRetinal Diseases.

Researchers conducted a search of various medical research databases and reviewed 27 studies on patients with spontaneous idiopathic FTMH closure. Inclusion criteria involved a report of 1 or more cases of spontaneous idiopathic FTMH closure with an in-depth description of clinical characteristics such as age, sex, hole size, and hole classification.

The researchers analyzed 68 eyes of 66 patients (average age 67.5 years, 62.7% women) who experienced spontaneous closure. They noted that average best corrected visual acuity improved from 20/78 to 20/33 (Snellen) after closure. The average hole diameter was 176.8 μm (range: 60-350 μm), and average optical coherence tomography-observed closure time was 4.5+4.9 months (range: 3 weeks to 24 months). Holes were primarily small in size and categorized as stage 2 according to International Vitreomacular Traction Study Group (IVTS) staging and Gass classification, respectively.  

The most frequently reported mechanism of spontaneous closure was retinal tissue bridging via retinal cell proliferation across the hole, which occurred in 24 eyes. Overall, the reported rate of spontaneous idiopathic FTMH closure ranged from 3% to 15%. Investigators noted that no demographic subgroup is more likely to have a spontaneous closure.  

“Holes in earlier stages based on Gass or OCT-modified Gass staging, or of smaller size based on IVTS classification, are more likely to close,” according to the researchers. “Although Gass classification is widely used clinically, IVTS staging provides greater reliability in practice to define the clinical characteristics of macular hole presentation and should be widely adopted.” 

Study limitations include a small sample size and the failure of many of the studies to report final best corrected visual acuity.    

Reference

Garg A, Ballios BG, Yan P. Spontaneous closure of an idiopathic full-thickness macular hole: a literature review. J Vitreoretin Dis. Published online October 24, 2021. doi:10.1177/24741264211049873