MEDICAL THERAPY FOR LARGE IDIOPATHIC FULL-THICKNESS MACULAR HOLES.

Purpose: To describe the characteristics and outcomes of eyes with idiopathic fullthickness macular holes that underwent initial medical management. Methods: This retrospective study included eyes with full-thickness macular holes that were initially managed with 1 month of topical therapy. Eligible subjects were treated with dorzolamide 2% three times a day, nepafenac 0.1% twice a day, and prednisolone acetate 1% four times a day. The primary end points was hole closure at one month and secondary end point was change in best-corrected visual acuity. Results: Ten subjects (mean age: 62.80 years; female: 50%) with unilateral full-thickness macular holes were studied. The mean basal diameter of the entire cohort at baseline was 824.1 mm (median 828 mm). Four (40%) of the smaller holes (mean 698 mm; median 698.50 mm) closed after 1 month of topical therapy, whereas larger holes (mean 908.17 mm; median 889.50 mm) did not close. In one eye, the hole reopened 4 months after stopping the medication but closed again at 1 month after restarting the topical treatment. Median best-corrected visual acuity improved from 0.35 logMAR at baseline to 0.05 logMAR in eyes that closed but remained at 0.70 logMAR at 1 month in eyes that did not close. Conclusion: Topical corticosteroid, nonsteroidal antiinflammatory, and carbonic anhydrase inhibitor therapy may promote closure of small full-thickness macular holes, but large holes are less likely to respond. One month of topical therapy might avoid subjecting some patients to complex vitreoretinal surgery without compromising visual outcomes. Macular hole may reopen after stopping the topical therapy. [ABSTRACT FROM AUTHOR]