Topical Drops to Close Macular Holes without Surgery

Article: Study finds medicated eye drops may help close macular holes without surgery
Source: University of Chicago Medicine, via Retinal Physician
Published: January 29, 2021

A retrospective multicenter case series explored the use of medicated eye drops to close small full-thickness macular holes (FTMHs). Depending on its size, a macular hole can cause distorted vision or an area of missing vision (scotoma) at the center of a person's field of view. For macular holes that do not close on their own, a vitrectomy can be performed. However, the gas bubble that serves as a temporary bandage to help the edges of the macular hole join and close requires the patient to remain face down for several days and nights so that the gas bubble can float in the correct position at the back of the eye. As with any intraocular surgery, vitrectomy also carries risks, notably cataract formation and retinal detachment. An alternative medical treatment to close macular holes could be attempted prior to considering surgery. The senior author of the study comments, “For certain patients, medicated drops may heal their macular hole by decreasing inflammation and increasing fluid absorption in the retina.” The study involved 14 patients prescribed a daily three-drug regimen of a steroid (prednisolone or difluprednate), an NSAID (ketorolac or bromfenac), and a carbonic anhydrase inhibitor (brinzolamide or dorzolamide). The study reports that 12 of the 14 patients had holes that closed within 2 to 8 weeks, 2-4 times faster than spontaneous closure rates. The treatment was most effective for patients whose macular holes were less than 200 microns in diameter, with treatment duration (including tapering) ranging from 3.5 to 20 months. The two patients who did not experience hole closure during the study duration had multiple missed follow-up appointments, the article noted. The researchers next plan to conduct a prospective randomized trial to definitively determine the benefits of the eye drops compared to the natural history of macular hole closure.

My rating of this study: ⭐⭐⭐

Sokol JT, Schechet SA, Komati R, et al. "Macular Hole Closure with Medical Treatment." Ophthalmology Retina.  15 December 2020. https://doi.org/10.1016/j.oret.2020.11.018