Topical therapy may be an effective treatment with high closure rates in patients with secondary full-thickness macular holes, and especially in those with small holes and cystoid macular edema, a small patient-based study in Ophthalmology Retina suggests.

The investigation included 12 secondary full-thickness macular holes that were evaluated between 2016 and 2019 at a referral-based retina practice.

Topical therapy was used in nine eyes (eight patients). Six of the nine macular holes were associated with prior retinal detachment. Pars plana vitrectomy had been performed in three eyes (one for retinal detachment and two for epiretinal membrane). One eye had vitreomacular traction and a remote history of blunt trauma. The average initial hole diameter was 79.6μm, and patients were followed up at about 53 weeks. Each of the full-thickness macular holes had some element of epiretinal membrane and cystoid macular edema.

All patients received difluprednate with the addition of a topical carbonic anhydrase inhibitor in six eyes and non-steroidal anti-inflammatory drops (NSAID) in two eyes. Eight eyes (89%) achieved successful hole closure and resolution of cystoid macular edema with concurrent improvement in visual acuity after about six weeks of therapy. Average vision among all nine eyes improved from 0.69 logMAR (Snellen equivalent of approximately 20/100) to 0.37 logMAR (Snellen equivalent of approximately 20/50).

Patients had no episodes of corneal melts or ulcers. One patient who was on the topical NSAID and steroid had mild keratopathy and elevation of intraocular pressure, but this resolved when the NSAID was stopped and difluprednate was tapered down to once a week.

Niffenegger JH, Fong DS, Wong KL, Modjtahedi BS. Treatment of secondary full-thickness macular holes with topical therapy. Ophthalmol Retina. January 28, 2020 [Epub ahead of print].