Macular Hole Surgical Techniques and Visual Outcomes

Full-thickness macular holes represent a common cause of central visual loss in adults and are typically managed by pars plana vitrectomy combined with adjunctive manoeuvres to promote hole closure. Internal limiting membrane (ILM) peeling remains the cornerstone technique, having elevated closure rates to over 90 percent and improved postoperative visual acuity substantially. Modifications such as inverted ILM flap or free-flap techniques aim to enhance outcomes in large or refractory holes, while novel variations in peeling patterns seek to minimise trauma to inner retinal layers. Gas tamponade and patient positioning, most notably facedown posturing, continue to influence anatomical success, particularly in holes exceeding 400 µm diameter. Recent adjuncts—including autologous platelet-rich plasma—have shown promise in restoring foveal architecture, and automated imaging algorithms now quantify subtle morphological changes. Simultaneously, machine-learning models are emerging to predict individual visual outcomes and guide personalised surgical planning. Together, these advances underscore a shift towards tailored approaches that balance maximising closure rates with preserving retinal integrity and optimising functional recovery.

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Macular Hole Surgical Techniques and Visual Outcomes publication trend

The graph below shows the total number of articles in macular hole surgical techniques and visual outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Internal limiting membrane (ILM) peeling: Surgical removal of the innermost retinal layer to relieve traction and promote macular hole closure.

Inverted ILM flap technique: A variant of ILM peeling in which a remnant flap is inverted over the hole to act as a scaffold for tissue migration.

Gas tamponade: Injection of an inert gas bubble into the vitreous cavity to appose retinal tissue and assist hole sealing.

Facedown positioning: Postoperative patient posture in which the face is oriented downward to maintain gas bubble contact with the macula.

Optical coherence tomography (OCT): Non-invasive imaging modality that captures high-resolution cross-sections of the retina.

logMAR: Logarithm of the minimum angle of resolution, a standard scale for quantifying visual acuity.

References

1. Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm. View (2023).
2. Facedown Positioning in Macular Hole Surgery A Systematic Review and Individual Participant Data Meta-Analysis. Ophthalmology (2024).
3. Uncertainty-aware regression model to predict post-operative visual acuity in patients with macular holes. Computerized Medical Imaging and Graphics (2024).
4. Long-Term Results of Adjunct Autologous Platelet-Rich Plasma in Lamellar Macular Hole Surgery Showing Lasting Restoration of Foveal Anatomy. International Journal of Molecular Sciences (2023).