OJOph  Vol.5 No.3 , August 2015
Managing Macular Holes in a Developing Economy
Abstract: Background: Macular holes are the common cause of visual impairment especially in the elderly and have a variety of etiological factors. The advances in the management of macular holes are encouraging and are now available in developing countries although scarce, where hitherto; patients seek attention outside their country. The need to understand this disease has therefore become pertinent in all retina clinics. Objective: To evaluate the pattern of presentation of macular holes and its management in a retina clinic in South South Nigeria. Methods: A 5 year retrospective, non comparative review of 24 consecutive cases presenting to a retinal clinic was carried out. Relevant information was extracted from the medical records and analyzed. Results: Three hundred and sixty four cases were seen between January 2009 and December 2013. Twenty four cases had macular holes and ten (41.7%) had bilateral presentation with a total of 34 eyes. The incidence of macular holes was 6.6%. The mean age was 46 years (SD ± 13.42) with a female preponderance, 5:1. Idiopathic holes formed the bulk of the cases 14(58.3%); others were trauma 4(16.7%), posterior uveitis 2, (8.3%), chemotherapy 2 (8.3%), Solar retinopathy and retinitis pigmentosa 1 (4.2%). Nineteen (55.9%) of the 34 eyes were visually impaired (BCVA <6/18). Nineteen eyes had full thickness holes (55.9%) requiring surgery, however only 3(12.5%) of these could afford to have surgery with one reoperation. Four patients (16.7%) had complications in form of retinal detachments at presentation. Conclusion: This study has shown that the incidence of macular holes in the developing world is significant and resources to manage these cases are grossly lacking. Specialist training, with government subsidizing costs will alleviate these difficulties and reduce visual loss from macular holes.
Cite this paper: Fiebai, B. and Pedro-Egbe, C. (2015) Managing Macular Holes in a Developing Economy. Open Journal of Ophthalmology, 5, 139-144. doi: 10.4236/ojoph.2015.53021.

[1]   Oh, K.T. (2013) Macular Hole Treatment and Management.

[2]   Ezra, E. (2001) Idiopathic Full Thickness Macular Hole: Natural History and Pathogenesis. British Journal of Ophthalmology, 85, 102-108.

[3]   Knapp, H. (1869) UeberIsolirtezerreissungen der aderhautinfolge von traumen auf augapfel. Archives of Ophthalmology and Otology (Archiv für Augenund Ohrenheilkunde), 1, 6-29.

[4]   Kuhnt, H. (1900) Tber eineeigentumlicheveranderung der netzhautadmaculam (retinitis atrophicanssiverareficanscentralis). Zeitschrift für Augenheilkunde, 3, 105.

[5]   Gass, J.D. (1988) Idiopathic Senile Macular Hole. Its Early Stages and Pathogenesis. Archives of Ophthalmology, 106, 629-639.

[6]   Aaberg, T.M. (1970) Macular Holes. A Review. Survey of Ophthalmology, 15, 139-162.

[7]   Gao, L., Dong, F. and Chan, W. (2007) Traumatic Macular Hole Secondary to Nd: YAG Laser. Eye, 21, 571-573.

[8]   García-Fernández, M., Castro-Navarro, J. and Bajo-Fuente, A. (2013) Unilateral Recurrent Macular Hole in a Patient with Retinitis Pigmentosa: A Case Report. Journal of Medical Case Reports, 7, 69.

[9]   Eisner, A. and Luoh, S.W. (2011) Breast Cancer Medications and Vision: Effects of Treatments for Early-Stage Disease. Current Eye Research, 10, 867-885.

[10]   Bonnin, N., Cornut, P., Chaise, F., Labeille, E., Manificat, H., Feldman, A., Perard, L., Bacin, F., Chiambaretta, F. and Burillon, C. (2013) Spontaneous Closure of Macular Holes Secondary to Posterior Uveitis: Case Series and Literature Review. Journal of Ophthalmic Inflammation and Infection, 3, 34.

[11]   Leibovitch, I., Azmon, B., Pianka, P., Alster, Y. and Loewenstein, A. (2003) Macular Hole Secondary to Branch Retinal Vein Occlusion Diagnosed by Retinal Thickness Analyzer. Ophthalmic Surgery, Lasers & Imaging, 34, 53-56.

[12]   Smiddy, W.E. and Flynn Jr., H.W. (2004) Pathogenesis of Macular Holes and Therapeutic Implications. American Journal of Ophthalmology, 137, 525-537.

[13]   Kelly, N.E. and Wendel, R.T. (1991) Vitreous Surgery for Idiopathic Macular Holes. Results of a Pilot Study. Archives of Ophthalmology, 109, 654-659.

[14]   McCannel, C.A., Ensminger, J.L., Diehl, N.N. and Hodge, D.N. (2009) Population Based Incidence of Macular Holes. Ophthalmology, 116, 1366-1369.

[15]   Sen, P., Bhargava, A., Vijaya, L. and George, R. (2008) Prevalence of Idiopathic Macular Hole in Adult Rural and Urban South Indian Population. Clinical and Experimental Ophthalmology, 36, 257-260.

[16]   Klein, R., Klein, B.E., Wang, Q. and Moss, S.E. (1994) The Epidemiology of Retinal Membranes. Transactions of the American Ophthalmological Society, 92, 403-425.

[17]   Rahmani, B., Tielsch, J.M., Katz, J., Gottsch, J., Quigley, H., Javitt, J., et al. (1996) The Cause-Specific Prevalence of Visual Impairment in an Urban Population. Baltimore Eye Survey. Ophthamology, 103, 1721-1726.

[18]   Mitchell, P., Smith, W., Chey, T., Wang, J.J. and Chang, A. (1997) Prevalence and Associations of Epiretinal Membranes. The Blue Mountains Eye Study, Australia. Ophthalmology, 104, 1033-1040.

[19]   Comander, J., Gardiner, M. and Loewenstein, J. (2011) High-Resolution Optical Coherence Tomography Findings in Solar Maculopathy and the Differential Diagnosis of Outer Retinal Holes. American Journal of Ophthalmology, 152, 413-419.

[20]   Macarez, R., Vanimschoot, M., Ocamica, P. and Kovalski, J.L. (2007) Optical Coherence Tomography Follow-Up of a Case of Solar Maculopathy. Journal Français d’Ophtalmologie, 30, 276-280.