Surgical Management of Full-Thickness Macular Holes in Macular Telangiectasia Type 2

To report on macular hole repair in macular telangiectasia type 2 (MacTel).Global, multicenter, retrospective case series.Patients with surgery for MacTel-associated full thickness macular hole (MTMH).A standardized data collection sheet was distributed to all surgeons.Anatomic closure and visual outcomes of MTMH RESULTS: Sixty-three surgeries in 47 patients with MTMH were included from 30 surgeons. Mean age was 68.1 years, with 62% females, 72% Caucasians, 21% East or South Asians, 2% African American, 2% Hispanic or Latino. Procedures included 34 internal limiting membrane (ILM) peeling alone, 22 ILM flaps, 5 autologous retinal transplantations (ARTs), 1 retinotomy, and 1 subretinal bleb. For ILM peels, preoperative best available visual acuity (VA) was logMAR 0.667 ± 0.423. Minimum hole diameter (MHD) was 305.5 ± 159.4 μm (range 34 - 573 μm). Sixteen of 34 ILM peels resulted in MTMH closure for a 47% success rate. At postoperative month 6 VA was stable at logMAR 0.608 ± 0.516 (P=0.65). VA improved at least 2 lines in 43% and at least 4 lines in 24%. For ILM flaps, preoperative VA was logMAR 0.878 ± 0.552. MHD was 440.8 ± 175.5 μm (range 97 - 697 μm), which was significantly larger than for ILM peels (P<0.01). Twenty of 22 ILM flaps resulted in MTMH closure for a 90% success rate, which was significantly higher for ILM flaps than for ILM peels (P<0.01). At postoperative month 6 VA improved to logMAR 0.555 ± 0.405 (P<0.05). VA improved at least 2 lines in 56% and at least 4 lines in 28%. For ARTs, preoperative VA was logMAR 1.460 ± 0.391. MHD was 390.2 ± 203.7 μm (range 132 - 687 μm). All 5 ARTs resulted in MTMH closure for a 100% success rate. At postoperative month 6 VA was stable at logMAR 1.000 ± 0.246 (P=0.08). VA improved at least 2 lines in 25%.Surgical closure of macular holes improved VA in 57% of MTMHs. ILM flaps achieved better anatomical and functional outcomes than ILM peeling alone. ART may be an option for refractory MTMHs.