Mantapond Ittarat,1,2 Thanapong Somkijrungroj,2,3 Sunee Chansangpetch,2,4 Pear Pongsachareonnont2,3

1Surin Hospital and Surin Medical Education Center, Department of Ophthalmology, Suranaree University of Technology, Surin, Thailand; 2Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; 3Vitreoretinal Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; 4Glaucoma Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Correspondence: Pear Pongsachareonnont Department of Ophthalmology, Faculty of Medicine 1873 Rama IV Road, Patumwan, Bangkok 10330, Thailand Tel +66-2256-4142 Fax +66-2-252-8290 Email pear.p@chulahospital.org

Purpose: To summarize current surgical techniques for treating primary macular holes (MHs). Methods: We reviewed publications detailing surgical approaches to primary MHs, briefly described their protocols, and outlined their results. Results: Currently, the technique for primary MH repair is pars plana vitrectomy, removing the posterior cortical vitreous, stripping the epiretinal membranes, and ending with intraocular gas tamponade. The evident benefit of peeling off the internal limiting membrane (ILM) was clearly shown for MHs at stages 2 to 4 by achieving an anatomical closure rate of > 90%, even in large MH up to 650 m. Newer MH surgical techniques include modification of ILM flap techniques, placing an autologous scaffolding of tissue within the hole, and cell therapy has shown to increase the closure rate of large and chronic macular holes, resulting in modest functional improvement in complicated MHs. Conclusion: Since the turn of the century, the success rate of modern macular surgery has increased, even for large and chronic MHs. There seems to be no limit to novel concepts in MH surgery, which range from anatomical closure to those proposing natural restoration of visual function via stem cell therapy.

Keywords: macular hole, macular hole surgery, stem cell therapy, internal limiting membrane peeling

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