Controversies, consensuses, and guidelines on macular hole surgery by the Asia–Pacific Vitreo-retina Society (APVRS) and the Asia–Pacific Academy of Professors in Ophthalmology (AAPPO)
Year: 2025
Type: review
Abstract: Macular hole surgery, primarily pars plana vitrectomy with internal limiting membrane peeling (ILM) and gas tamponade, has become the standard of care for full-thickness macular hole (FTMH). Despite the 85% to 95% anatomical closure rate, several aspects of the procedure are well accepted whereas some may remain controversial among vitreoretinal surgeons. An international panel of experts (IPE) comprising 27 experts from 10 countries/territories was established to evaluate a total of 38 consensus statements on ILM peeling extent, vital dye selection, face-down positioning requirements, tamponade options, timing of surgery and re-surgery, management of difficult and refractory cases, and adjuvant therapies. The objective is to synthesize evidence-based real-world practice recommendations from leading global experts to guide the management of FTMH. Of the 38 statements, the IPE reached consensus (75% voted as "Strong Agreement" or "Agreement") on 29 (76.3%). The IPE emphasized the importance of individualized patient factors-such as hole size, chronicity, lens status, and preoperative visual acuity-in surgical planning and tempering patient's postoperative expectations. There was strong agreement on the need of adequate peeling of the ILM, adjunctive measures including the inverted ILM flap, and face-down positioning for large and refractory FTMH. Controversial statements, such as the use of air tamponade or observation of small FTMH, not reaching consensus are identified. We hope the consensus statements agreed and disagreed by the IPE would help serve as good reference and guidelines in managing FTMH.
Source: Eye and Vision
Authors: Nishant V. Radke, Paisan Ruamviboonsuk, David H. Steel, Tian Tian, Alex P. Hunyor, Andrew S. H. Tsai, Andrew Chang, Chung-May Yang, Chi-Chun Lai, Fangtian Dong, Jennifer I. Lim, Jay Chhablani, Kenny H. W. Lai, Mahesh P. Shanmugam, Peter Stalmans, Pradeep Venkatesh, Robert F. Lam, Se Joon Woo, Shaochong Zhang, Taraprasad Das, Timothy Y. Y. Lai, Vinod Kumar, Xin Huang, Zhaotian Zhang, Zhaoyang Wang, Peiquan Zhao, Dennis S. C. Lam
Institutions: Chinese University of Hong Kong, Shenzhen, Rajavithi Hospital, Rangsit University, Sunderland Eye Infirmary, Newcastle University, Shanghai Jiao Tong University, XinHua Hospital, The University of Sydney, Singapore National Eye Center, Singapore Eye Research Institute, Duke-NUS Medical School, National Taiwan University, National Taiwan University Hospital, Chang Gung Memorial Hospital, Keelung Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, University of Illinois Chicago, University of Pittsburgh, Chinese University of Hong Kong, Sankara Eye Hospital, Bangalore, Universitair Ziekenhuis Leuven, All India Institute of Medical Sciences, Caritas Medical Centre, Seoul National University, Seoul National University Bundang Hospital, Jinan University, L V Prasad Eye Institute, Fudan University, Eye & ENT Hospital of Fudan University, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Beijing Tongren Hospital, Capital Medical University
Language: English
Topic: Retinal and Macular Surgery
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,790
Awards: G3231526350, G7977749542
OpenAlex ID: W4412688917