From Peel to Plug: Sealing The Gap With Surgical Innovations For Macular Hole Repair

Authors

  • Milena Cioana, MD Department of Ophthalmology and Vision Sciences, University of Toronto., Toronto, ON
  • Tina Tang, MD, FRCSC Department of Ophthalmology and Vision Sciences, University of Toronto., Toronto, ON
  • Peng Yan, MD, FRCSC Department of Ophthalmology and Vision Sciences, University of Toronto., Toronto, ON

DOI:

https://doi.org/10.58931/cect.2025.4262

Abstract

The surgical management of macular holes (MH) has evolved significantly over the past few decades. In 1991, Kelly and Wendel revolutionized MH repair by introducing pars plana vitrectomy combined with air fluid exchange. Eckardt et al. in 1997 further advanced and improved the success of macular hole closure by introducing internal limiting membrane (ILM) peeling, establishing the gold standard for idiopathic MH treatment. The subsequent development of micro-incision vitrectomy systems, particularly 25- and 27-gauge instrumentation, has resulted in better wound sealing, reduced postoperative inflammation, and faster visual recovery. These technological advancements laid the foundation for more complex surgical approaches, especially in complex cases such as large, recurrent, persistent, traumatic or myopic MHs. Contemporary techniques now include a variety of ILM flap methods (e.g., inverted, temporal, single-layer, and multilayered/petal flaps), autologous ILM transplantation (AILMT), human amniotic membrane (hAM) grafts, and autologous retinal transplantation (ART).

Author Biographies

Milena Cioana, MD, Department of Ophthalmology and Vision Sciences, University of Toronto., Toronto, ON

Milena Cioana, MD is a resident physician in the Department of Ophthalmology and Vision Sciences at the University of Toronto. She completed her medical degree at the University of Toronto, where she developed a strong interest in ophthalmology. Her academic interests include ocular disease, surgical innovation, and medical education.

Tina Tang, MD, FRCSC, Department of Ophthalmology and Vision Sciences, University of Toronto., Toronto, ON

Dr. Tina Tang completed her medical degree at McGill University and her Ophthalmology residency at the University of Manitoba. Following medical school, she undertook an Ocular Pathology Research Fellowship under Dr. Brownstein at the University of Ottawa. Currently, Dr. Tang is completing her subspecialty vitreoretinal surgery fellowship at the University of Toronto. In parallel with her surgical training, she is pursuing a Master of Public Health at Johns Hopkins University, with a focus on population-level strategies to prevent vision loss and expand access to eye care.

Peng Yan, MD, FRCSC, Department of Ophthalmology and Vision Sciences, University of Toronto., Toronto, ON

Dr. Peng Yan, MD, is an Associate Professor of Ophthalmology and Visual Sciences at the University of Toronto, specializing in medical and surgical retina. He earned his MD from the University of British Columbia and completed his residency in Ophthalmology at the University of Ottawa, followed by advanced fellowship training in surgical retina at the University of Toronto. Dr. Yan serves as a vitreoretinal surgeon and clinician-scientist at the University of Toronto, holding pivotal roles including Chair of Retina Education, Director of the Ophthalmic Electrophysiology Lab, and Director of the Medical Retina and Uveitis Fellowship Program. His research focuses on advancing treatments for vitreoretinal diseases such as diabetic retinopathy, retinal detachment, and macular degeneration. Dr. Yan integrates innovative surgical techniques and artificial intelligence into ophthalmology, leading projects on novel vitreous substitutes, intravitreal drug delivery devices, stem-cell therapy for AMD, and the application of human tear cytokines in disease evaluation. Dr. Yan has authored over 90 peer-reviewed articles, reviews, and book chapters, and presented his research at international conferences including the American Academy of Ophthalmology, American Society of Retina Specialists, and Association for Research in Vision and Ophthalmology. He has served as a panelist, moderator, and chair, influencing global retina research and clinical practice. Recognized for his impactful contributions, Dr. Yan has received prestigious awards from the American Society of Retina Specialists, including distinctions as a Master Contributor. His leadership and pioneering research continue to advance ophthalmology, enhancing patient care worldwide.

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Published

2025-08-11

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1.
Cioana M, Tang T, Yan P. From Peel to Plug: Sealing The Gap With Surgical Innovations For Macular Hole Repair. Can Eye Care Today [Internet]. 2025 Aug. 11 [cited 2025 Aug. 18];4(2):35–43. Available from: https://canadianeyecaretoday.com/article/view/4-2-Cioana_et_al

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Volume 4, Issue 2, Summer 2025

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