**Chapter 4** Macular Hole Surgery

*Sergio Scalia, Peter Reginald Simcock, Simone Scalia, Daniela Angela Randazzo and Maria Rosaria Sanfilippo*

## **Abstract**

Macular hole surgery is one of the most rapidly changing fields in vitreoretinal surgery, the authors discuss the recent acknowledgments and surgical options. Macular holes are classified, and surgical techniques are described in order to have the most successful procedure. Diagnostic tools and surgical instruments improvement allow surgeons to face difficult cases with a variety of surgical options unknown until a few years ago and is mandatory nowadays to approach the different patients with a broad mind.

**Keywords:** macular hole, vitrectomy, inner limiting membrane, expansile gas, autologous platelet concentrate, human amniotic membrane, retinal graft

#### **1. Introduction**

A macular hole (MH) is a full-thickness defect of the neurosensory retina involving the fovea **Figures 1** and **2**. The prevalence of macular holes is estimated at 0.1% in individuals aged 40 years or older and 0.8% in those aged over 74 years. Idiopathic macular holes account for up to 85% of all macular holes. Other causes include blunt trauma, high myopia, macular schisis, macular telangiectasia type 2, wet age-related macular and surgical trauma [1, 2]. Most patients are females over 65 years of age and may also be seen with myopic eyes [3].

### **2. Pathogenesis of idiopathic MH**

The posterior vitreous cortex exhibits anteroposterior and tangential traction forces on the fovea [4]. The role of vitreomacular tractions in the formation of the MH is supported by the reduced incidence of bilateral MH in patients with a posterior vitreous detachment (PVD) in the fellow eye as a PVD significantly reduces the risk of MH formation [5].

### **3. Clinical presentation**

Patients with macular hole usually present with decreased vision, central scotoma and metamorphopsia. Slit-lamp bio-microscopy with 78, 90 D or a fundus contact lens
