Full-Thickness Macular Hole Closure with Topical Medical Therapy.

PURPOSE: To examine the efficacy and clinical characteristics of successful full-thickness macular hole (FTMH) closure with topical therapy.

METHODS: Retrospective case series of FTMHs managed by a single retinal physician (DS) diagnosed and treated from 2017-22.

RESULTS: Of 168 patients with FTMHs, 71 patients were started on steroid, carbonic anhydrase inhibitor (CAI), and non-steroidal anti-inflammatory (NSAID) drops. 49 patients (mean 67yrs, 59% women) were included in the analysis; 22 were excluded for poor follow-up. 7/49 were secondary post-PPV holes and 42/49 were idiopathic. 18/49 eyes (36.7%) achieved closure on topical therapy, of which 13 were idiopathic. Hole size was directly correlated with odds of closure: for every 10-micron decrease in size, odds of closure increased by 1.2x (p=0.001, CI 1.1-1.4). Average time to closure was 107.2 days (range 20-512 days), and was not correlated to hole size (p=0.217, CI -0.478-+1.938). The presence of VMT was found to be inversely related to successful closure (OR 6.1, p=0.029, CI 1.2-31.3). There was no significant difference in final BCVA for eyes undergoing primary PPV versus those trialing drops before undergoing PPV (p=0.318, CI -0.094-+0.112).

CONCLUSION: In the first study to-date to report the overall efficacy and clinical characteristics of successful macular hole closure with topical therapy, drops achieved an overall closure rate of 36.7%, with higher efficacy in smaller holes and those without VMT. Rates of MH narrowing and reduction in CFT acted as predictors of effectiveness of drop therapy.