Surgical advancements in recent years have greatly increased the success rate of hole closure for patients with full-thickness macular hole (FTMH). When investigated previously, small sample-sized studies suggested that epiretinal membrane (ERM) or epiretinal proliferation (EP) had little to no impact on outcomes of FTMH surgery. Now, 20 years later, research shows ERM is associated with failure of hole closure and unfavorable hole closure, and the presence of EP may also significantly impact surgical outcomes.

The observed data in this case-control study included 534 eyes of 534 patients who underwent surgery for FTMH. The number of patients with FTMH combined with ERM was 163. The primary measured outcome was failure of the MH closure, and the secondary outcome was unfavorable hole closure (V or λ type closure) at six months post-op. 

Results from the study concluded that patients with ERM were two to three times more likely to have failure of MH closure and unfavorable MH closure (even if the hole is closed postoperatively). They also found that ERM spanning the hole margin (HM-ERM) significantly increased the likelihood of unfavorable hole closure.

“Compared to the patients without ERM, the group with combined FTMH and ERM had significantly higher proportions of men (31.5% vs. 44.2%), presence of EP (5.4% vs. 17.2%), and RPE damage (29.6% vs. 39.3%) and significantly lower proportions of VMT (26.1% vs. 17.8%), operculum (36.1% vs. 12.3%) and macular hole above 400 μm in size (59.3% vs. 45.4%),” the authors of the study wrote. “However, there was no difference in length of pre-operative symptoms (5.9 months vs. 5.5 months) between groups.”

“Failure of hole closure was observed in 27 (21.3%) patients with ERM, compared with 15 patients (11.8%) without ERM...Interestingly, patients with combined HM-ERM and EP in FTMH had a significantly higher likelihood of failure of macular hole closure (38.4%) compared to patients without ERM (11.8%),” the authors observed.

Improving the capability of MH surgery to preserve macular anatomical integrity, including the OPL and outer-retinal layer, could mean higher success rates and better outcomes for patients with combined FTMH and ERM or EP.