Macular Hole Treatment. Different Methods

Since the initial report on pars plana vitrectomy (PPV) for macular holes in 1991 by Kelly and Wendell [1], vitreous surgery has been established as a standard treatment for macular holes. The main goal of surgical management is removing tangential and anterior–posterior traction around the hole and immobilization and connection of hole edges. Therefore posterior hyaloid, the ILM, and epiretinal membranes must be removed. The traction exerted by the posterior hyaloid on the macula should be relieved by either removing perimacular vitreous alone or combining it with the induction of a complete posterior vitreous detachment. Various surgical techniques have been described to accomplish this task. I use the vitrectomy cutter with the maximum aspiration. The posterior hyaloid membrane in this case, as a rule, leaves from the underlying retina and shifts to the center of the vitreous cavity. Then, it may be removed with the vitrectomy cutter. Visualization agents, such as triamcinolone acetonide, may assist in the identification of remaining posterior hyaloid.