Macular holes are a common cause of visual impairment. The randomized trial performed by Freeman et al1 for the Vitrectomy for Treatment of Macular Hole Study Group provides several pieces of important information about this prevalent condition. The results confirm that a large proportion of stage 3 and 4 macular holes close after vitrectomy, that such closure can occur even after a long duration, and that the anatomical results depend on the size and duration of the hole. The difference between the eyes assigned to vitrectomy (69% closure) and control eyes (4% closure) is statistically significant. The question then becomes whether this anatomical result translates into clinical visual improvement. The clinical results are mixed; improvements in visual acuity and serious adverse events were more common in the operated on eyes than in the control eyes, and both of these changes occurred in less than one quarter of these eyes.
Hillis A, Fine SL. Verdict on Macular Hole SurgeryMore Data Needed. Arch Ophthalmol. 1997;115(1):112. doi:10.1001/archopht.1997.01100150114020