Surgical Management of Macular Holes

In this chapter, the authors discuss full-thickness macular hole (FTMH) surgery. The types of FTMHs, their pathogenesis, and classification are explored, emphasizing the role of vitreomacular traction and internal limiting membrane (ILM) forces. Surgical strategies for macular hole management are outlined, ranging from pars plana vitrectomy (PPV) alone to combined approaches involving ILM peeling for primary macular holes. For large (> 650 μm in minimal linear diameter), chronic, and myopic holes, surgical techniques such as inverted and non-inverted ILM flaps are detailed, along with emerging options like autologous retinal transplants and other tissue scaffold alternatives. The role of tamponades, positioning, and patient counseling are discussed in relation to postoperative outcomes. This focused overview equips surgeons with insights into the macular hole management, offering a tailored surgical approach to achieving successful closure and visual rehabilitation.