ICO International Clinical Guidelines:

Idiopathic Macular Hole (Initial Evaluation and Therapy)

(You can also download this Guideline as a PDF file - 110 KB)

On this page:

• Initial exam history
  
  
• Initial physical exam
  
  
• Management recommendations
  
  
• Surgical and postoperative care
  
  
• Patient education

Initial Exam History (Key elements)

• Duration of symptoms [A:III]
  
  
• Ocular history: glaucoma or other prior eye diseases, injuries, surgery, or other treatments; prolonged gazing at the sun [A:III]
  
  
• Medications that may be related to macular cysts [A:III]

Initial Physical Exam (Key elements)

• Visual acuity [A:III]
  
  
• Slit-lamp biomicroscopic examination of the macula and the vitreoretinal interface [A:III]Binocularity/stereoacuity testing [A:III]

Management Recommendations for Macular Hole

Stage	Management	Follow-up [A:III]
1-A	Observation [A:II]	Prompt return if new symptoms Every 4 to 6 months in the absence of symptoms
1-B	Observation [A:II]	Prompt return if new symptoms Every 4 to 6 months in the absence of symptoms
2	Surgery [A:II]*	1 to 2 days postoperatively, then 1 to 2 weeks Frequency and timing of subsequent visits varies depending on the outcome of surgery and the patient’s symptoms If no surgery, every 4 to 8 months
3	Surgery [A:I]	1 to 2 days postoperatively, then 1 to 2 weeks Frequency and timing of subsequent visits varies depending on the outcome of surgery and the patient’s symptoms
4	Surgery [A:I]	1 to 2 days postoperatively, then 1 to 2 weeks Frequency and timing of subsequent visits varies depending on the outcome of surgery and the patient’s symptoms

*Although surgery is usually performed, observation is also appropriate.

Surgical and Postoperative Care if Patient Receives Treatment

• Inform the patient about relative risks, benefits, and alternatives to surgery, and the need for use of expansile intraocular gas or special patient positioning postoperatively (A:III)
  
  
• Formulate a postoperative care plan and inform the patient of these arrangements (A:III)
  
  
• Inform patients with glaucoma of possible perioperative increase in IOP (A:III)
  
  
• Examine postoperatively within 1 or 2 days and again 1 to 2 weeks after surgery (A:III)

Patient Education

• Inform patients to notify their ophthalmologist promptly if they have symptoms such as increase in floaters, a loss of visual field, or a decrease in visual acuity (A:II)
  
  
• Inform patients that air travel, high altitudes, or general anesthesia with nitrous oxide should be avoided until the gas tamponade is nearly completely gone (A:III)
  
  
• Inform patients who have had a macular hole in one eye that they have a 10% to 20% chance of macular hole formation in the fellow eye, especially if the hyaloid remains attached (A:III)
  
  
• Refer patients with functionally limiting postoperative visual impairment for vision rehabilitation (see www.aao.org/smartsight) and social services (A:III)
  
  

* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2008 (www.aao.org)

(You can also download this Guideline as a PDF file - 110 KB)

Next: Keratorefractive Surgery (Initial and Follow- Up Evaluation)

Also see:

• International Clinical Guidelines (Preface)
  
  
• Introduction to the Guidelines
  
  
• List of Guidelines