A 62-year-old woman has decreased vision with metamorphopsia. OCT confirms a full-thickness idiopathic macular hole involving the fovea with cuff of subretinal fluid. Visual acuity is 6/36. What is the definitive management?

• A Intravitreal anti-VEGF injection every month
• B Observation with repeat OCT in 3 months
• C Focal argon laser photocoagulation to the hole margins
• D Pars plana vitrectomy with internal limiting membrane peeling, gas tamponade and postoperative prone positioning ✓

Explanation

Full-thickness idiopathic macular holes with significant visual loss are treated by vitrectomy with internal limiting membrane peeling, fluid-air-gas exchange and prone positioning for several days, achieving closure rates above 90 percent. Anti-VEGF agents act on vascular permeability and have no role in closing a full-thickness hole, and observation rarely reverses a stage 3 or 4 hole. Laser to the margins is destructive and would enlarge the defect.

Reference: Kanski's Clinical Ophthalmology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.