Miller AG, Chandra R, Pophal C, Schartman JP, Hornik JH, Miller DG. Efficacy of Macular Hole Surgery in Patients with Idiopathic Macular Telangiectasia Type 2. Ophthalmol Retina. 2020;4(5):494-497.
Idiopathic macular telangiectasia (IMT) type 2 is a neurodegenerative retinal disorder that can occasionally lead to full-thickness macular hole (FTMH) formation. Limited data, however, exists on the utility of standard macular hole surgery for improvement in structural and functional parameters in FTMH from IMT type 2. The present study retrospectively analyzed outcomes of eyes with FTMH secondary to IMT type 2 managed either surgically (n = 12) or with observation (n = 26).
Of the 12 eyes that underwent surgery, 10/12 had reduction in macular hole size but only 4/12 (25%) had hole closure at 12 months. However, vision did not improve in either the surgically-managed or observation groups. The authors concluded that vitrectomy for the management of FTMH in IMT type 2 does not appear to be beneficial. The authors correctly recognize that FMTH in IMT cannot be compared to idiopathic FTMH as the underlying etiologies are vastly different. While idiopathic FTMH are related to anteroposterior and tangential tractional forces on the retina, FTMH in IMT type 2 are related to progressive neurodegeneration of the retina. These neurodegenerative changes lead to cavitary changes which may coalesce to form a macular hole. While surgical intervention may allow for hole closure with gliotic changes in a small subset, outer retinal anatomy is not restored and thus vision does not improve.
The take home point from this study is that standard vitrectomy with ILM peeling is likely not beneficial in FTMH from IMT type 2. What remains to be understood, however, is whether novel macular hole surgical techniques such as ILM flaps, autologous retinal transplants and/or amniotic membrane grafts provide any functional improvement over standard surgical techniques in such challenging cases.
Akshay S. Thomas, MD