Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2: A Global Multicenter Study

Jong G. Park, Sean D. Adrean, Tedi Begaj, Antonio Capone, Steve Charles, San Ni Chen, Hung Da Chou, Michael N. Cohen, Stephanie Trejo Corona, Lisa J. Faia, Sunir J. Garg, Bruce R. Garretson, Ninel Z. Gregori, Julia A. Haller, Odette Margit Houghton, Jason Hsu, Jaehyuck Jo, Richard S. Kaiser, Chi Chun Lai, Mohamed Moghazy MahgoubMahsaw Mansoor, Ryo Matoba, Yuki Morizane, Marcio B. Nehemy, Paul V. Raphaelian, Carl D. Regillo, Alan J. Ruby, Margaret M. Runner, Scott R. Sneed, Elliott H. Sohn, Marc J. Spirn, James F. Vander, Taku Wakabayashi, Jeremy D. Wolfe, Charles C. Wykoff, Yoshihiro Yonekawa, Young Hee Yoon, Tamer H. Mahmoud

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To report on macular hole repair in macular telangiectasia type 2 (MacTel2). Design: Global, multicenter, retrospective case series. Participants: Patients undergoing surgery for MacTel2-associated full-thickness macular hole (MTMH). Methods: Standardized data collection sheet distributed to all surgeons. Main Outcome Measures: Anatomic closure and visual outcomes of MTMH. Results: Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% female, 72% White, 21% East or South Asian, 2% African American, and 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peeling, preoperative visual acuity (VA) was 0.667 ± 0.423 logarithm of the minimum angle of resolution (logMAR). Minimum hole diameter (MHD) was 305.5 ± 159.4 μm (range, 34–573 μm). Sixteen of 34 ILM peels (47%) resulted in MTMH closure. At postoperative month 6, VA was stable at 0.602 ± 0.516 logMAR (P = 0.65). VA improved by at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was 0.878 ± 0.552 logMAR. MHD was 440.8 ± 175.5 μm (range, 97–697 μm), which was significantly larger than for ILM peels (P < 0.01). Twenty of 22 ILM flaps (90%) resulted in MTMH closure, which was significantly higher than for ILM peels (P < 0.01). At postoperative month 6, VA improved to 0.555 ± 0.405 logMAR (P < 0.05). VA improved by at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was 1.460 ± 0.391 logMAR. MHD was 390.2 ± 203.7 μm (range, 132–687 μm). All 5 ARTs (100%) resulted in MTMH closure. At postoperative month 6, VA was stable at 1.000 ± 0.246 logMAR (P = 0.08). Visual acuity improved at least 2 lines in 25%. Conclusions: Surgical closure of macular holes improved VA in 57% of MTMHs. Internal limiting membrane flaps achieved better anatomic and functional outcomes than ILM peeling alone. Autologous retinal transplantation may be an option for refractory MTMHs. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Original languageEnglish
Pages (from-to)66-77
Number of pages12
JournalOphthalmology
Volume131
Issue number1
DOIs
StatePublished - Jan 2024
Externally publishedYes

Keywords

  • Autologous retinal transplantation
  • Full-thickness macular hole
  • Internal limiting membrane flap
  • Internal limiting membrane peeling
  • Macular telangiectasia type 2

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