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Macular Holes: Observe, Inject, or Operate? – By Charles Mayron, MD, FACS

Focal VMT and FTMH: Observe, Inject, or Operate?

My approach

By Charles Mayron, MD, FACS

Retinal Physician – www.retinalphysician.com

Our firsthand clinical observations influence the choices we make for patients. Evidence-based medicine rarely provides all the information. Pivotal clinical trials can guide us, while prior therapy often influences our decisions.

My approach to treating vitreomacular traction (VMT) and full thickness macular holes (FTMHs) utilizes the three-dimensional video feature of the Heidelberg Spectralis OCT. Treatment should not be based on a single horizontal or vertical scan but rather by the cube of video information of the vitreoretinal interface.

VMT and FTMH progression can be seen as a “tug-of-war” between the forces generated by the posterior hyaloid with that of the active transport mechanism within the RPE. The following cases demonstrate important considerations that can guide diagnosis and management of symptomatic patients with focal VMT without ERM, and FTMHs
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