Idiopathic Full Thickness Macular Holes: Classification and Current Management Approaches

Idiopathic, full-thickness macular holes (iFTMH) are foveal defects involving all neuroretinal layers, accounting for 85% of macular holes. They arise from age-related vitreous changes causing vitreomacular traction and subsequent hole formation, with peak incidence between the ages 60 to 70, and a 2-3 times greater incidence in women. Symptoms include blurred vision, decreased visual acuity, metamorphopsia or central scotoma. Prompt identification is crucial to ensure appropriate management, as although a minority of cases resolve spontaneously, timely surgical intervention remains the mainstay of treatment to restore anatomy and optimise visual function (4). Advances in vitreoretinal surgery, including pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and emerging techniques such as inverted ILM flaps having improved closure rates, even for chronic or large holes. This review provides a concise overview of the diagnosis, classification and management of iFTMHs.