Can macular hole be cured

Macular holes can actually be treated, but patients must pay attention to the correct method. Surgical treatment can be said to be more effective. The purpose of surgery is to relieve vitreomacular traction. Therapeutic vitrectomy is a commonly used surgical method.

1. Surgical treatment of macular holes was previously a forbidden area and was only considered when there was a large area of ​​peripheral retinal detachment. In recent years, due to the study of the pathogenesis of macular holes, it has been recognized that the formation of macular holes is closely related to the traction of the vitreous body on the tangential direction of the fovea. Therefore, vitrectomy to remove the vitreous cortex in front of the fovea has been widely used to treat macular holes. The purpose of surgery is to relieve vitreous-macular traction. For patients in stage I, removal of the vitreous, especially the posterior vitreous cortex in front of the macular area, can reposition the detached central fovea. For patients who have formed a full-thickness macular hole, the surgical objectives are multifaceted, including relieving vitreous-macular traction, peeling off the epiretinal membrane or inner retinal limiting membrane associated with the onset of the macular hole, and filling the eye with gas to close the macular hole. For refractory macular holes (such as large holes or recurrent holes), the use of autologous serum, β2 transforming growth factor (TGF-β2), or autologous platelet concentrates applied to the macular hole may increase choroidal retinal adhesion in the hole area and promote hole closure and healing.

2. Indications (1) Therapeutic vitrectomy: The purpose is to promote the closure of macular holes and the repositioning of shallow retinal detachments around the holes. A． Patients were clearly diagnosed with stage II to IV idiopathic macular hole, with significantly decreased visual acuity (0.05 to 0.4) and obvious visual distortion. B. Patients with macular hole formation within one year and willing to undergo surgery. (2) In Gass's staging of macular holes, stage I macular holes do not form full-thickness macular holes. About half of patients with stage I macular holes can spontaneously improve. Therefore, surgery is not recommended for stage I macular holes. For patients at high risk of developing full-thickness macular holes, surgery can be carefully considered. Whether vitrectomy can prevent the formation of full-thickness macular holes remains to be determined. The results of a multicenter, randomized, controlled clinical study in the United States showed that for patients with stage I macular holes, the incidence of full-thickness macular holes was 37% and 40% in the vitrectomy group and the non-surgery observation group, respectively (P=0.81). Due to the small number of cases observed, the efficacy of preventive surgery cannot be confirmed at present. Therefore, the pros and cons of performing preventive vitrectomy to treat stage I macular holes need to be weighed. The "pros" of the surgery are to relieve the mechanical traction of the vitreous on the macula, while the "disadvantages" are the possible risks of the surgery, including: surgical operations may cause full-thickness macular holes, iatrogenic holes in the peripheral retina, retinal detachment, infection, lens opacities, etc.

3. Surgical methods and progress Traditional surgical techniques include standard three-incision pars plana vitrectomy, artificial posterior vitreous detachment, subtotal vitreous removal, peeling of the epiretinal membrane or inner limiting membrane of the retina in the macular area, or closure of the macular hole with the help of biological agents. Use 20% to 25% SF6 gas for expansion gas/air exchange. After the operation, the patient lies prone for about 14 days, during which the gas in the vitreous cavity is absorbed and the patient returns to normal position. ?