Management options for early stages of acutely symptomatic macular holes.

PURPOSE To evaluate management options for acutely symptomatic stage I macular holes, and vitrectomy with intraocular gas tamponade for advanced stage I macular holes. METHODS Retrospective noncomparative study. SETTING Clinical practice. STUDY POPULATION Acutely symptomatic stage I macular holes. MANAGEMENT OPTIONS: (I) spontaneous resolution with observation -7 eyes; (II) stage I holes developing poor visual acuity of 20/50 or worse during observation -9 eyes undergoing pars plana vitrectomy, posterior vitreous separation, fluid -20% sulfur hexafluoride gas exchange; (III) stage I holes acutely progressing to stage II or III during observation -9 eyes with vitrectomy, posterior vitreous separation, membrane peel, fluid -18% perfluoropropane gas exchange. MAIN OUTCOME MEASURES visual acuity of 20/40 of better, prevention, or closure of macular hole. RESULTS Spontaneous resolution developed in 7 eyes with 20/40 or better vision (group I). 8/9 eyes undergoing vitrectomy for advanced stage I holes (group II) did not progress and recovered 20/40 or better vision. 1/9 recovered 20/40 vision after further surgery. 9/9 eyes following acute progression to full-thickness holes (group III) had closed macular holes with recovery of 20/40 vision after vitrectomy. CONCLUSIONS Stage I macular holes can initially be observed. However, excellent visual and surgical results can be obtained in stage I holes with poor vision, or with acute progression to full-thickness holes.