Macular Holes

Macular holes (MH) are full-thickness defects of the neurosensory retina in the foveal region, resulting from abnormal vitreoretinal traction, commonly associated with posterior vitreous detachment (PVD). Idiopathic MHs are the most frequent form, primarily affecting individuals in their sixth and seventh decades, with a higher prevalence among women. Optical coherence tomography (OCT) plays a crucial role in diagnosis, classification, and surgical planning. Classification systems, including those proposed by Gass, the International Vitreomacular Traction Study Group (IVTS), and the CLOSE study group, consider anatomical features, vitreomacular adhesion status, and surgical outcomes. Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains the gold standard for MH repair, achieving closure rates of up to 90% for holes ≤650 μm. For larger, recurrent, or myopic MHs, advanced techniques such as inverted ILM flap, macular hydrodissection, human amniotic membrane grafts, and autologous retinal transplant (ART) are indicated, improving anatomical and functional outcomes. Understanding MH pathogenesis, classification, and evolving surgical approaches is essential for optimizing patient care and visual recovery.