Temporal Arcuate Relaxing Retinotomy for Persistent Full-Thickness Macular Holes: Anatomical and Functional Assessment

TL;DR

This study evaluates a surgical technique for persistent macular holes, showing improved closure rates and visual acuity in a small group of patients.

Contribution

The study presents real-world outcomes of temporal arcuate relaxing retinotomy for persistent macular holes after standard repair failure.

Findings

OCT-confirmed closure was achieved in 7 out of 9 eyes (77.8%) after the procedure.

Best-corrected visual acuity improved in 8 out of 9 eyes (88.9%) following the surgery.

Only one patient reported a new scotoma, which was subjectively well tolerated.

Abstract

Background: Evidence guiding secondary repair of persistent full-thickness macular holes (FTMHs) remains limited and heterogeneous. Temporal arcuate relaxing retinotomy has been described as a salvage maneuver intended to increase temporal retinal compliance, yet functional safety data are scarce. We report consecutive real-world outcomes of temporal arcuate relaxing retinotomy for persistent FTMHs after failed standard repair(s). Methods: Retrospective consecutive case series of patients with persistent FTMH after ≥1 pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, treated with repeat PPV and temporal arcuate relaxing retinotomy. Outcomes included OCT (Optical Coherence Tomography)-confirmed closure after gas absorption and best-corrected visual acuity (BCVA, logMAR), ellipsoid zone (EZ) status, retinotomy-site morphology on OCT/fundus autofluorescence (FAF), and safety/functional outcomes (systematic scotoma symptom inquiry; Humphrey visual field testing when feasible). Exact binomial 95% confidence intervals (CI) were calculated for proportions. Results: Nine eyes (median age 70 years; range 55–76) underwent temporal arcuate relaxing retinotomy for persistent FTMH. Minimum linear diameter ranged 412–1037 µm (median 613 µm). OCT-confirmed closure was achieved in 7/9 eyes (77.8%; 95% CI 40.0–97.2) at a mean follow-up of 5.9 months (range 2–12). BCVA improved in 8/9 eyes (88.9%; 95% CI 51.8–99.7); mean BCVA improved from 1.26 ± 0.51 logMAR pre-operatively to 0.61 ± 0.18 logMAR at last follow-up (mean change −0.64 logMAR; Wilcoxon signed-rank test p = 0.011). As a sensitivity analysis, the paired t-test yielded p = 0.008. Humphrey visual fields were obtained in 6/9 eyes; one patient reported a new paracentral nasal scotoma, which was subjectively well tolerated. Conclusions: In this small consecutive series, temporal arcuate relaxing retinotomy was associated with a 78% closure rate and mean BCVA improvement in eyes with persistent FTMH after failed standard repair(s), with limited symptomatic scotoma reporting in those assessed. Given the retrospective design, small cohort, and incomplete standardized functional testing, larger comparative studies with uniform functional endpoints (microperimetry, RNFL/GCL metrics, and systematic perimetry) are needed to define patient selection, reproducibility, and relative performance versus contemporary salvage options.

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