The pathogenesis of macular holes in eyes with background of age-related macular degeneration (AMD) and the potential causative relationship between these entities remains unclear. In this narrative review, we aim to explore the intricate relationship between the formation of macular holes, both full-thickness and lamellar, and neovascular / non-subtype of AMD. A literature search was performed using the National Center for Biotechnology Information (NCBI) PubMed database, and studies published up to March 2025 were included. We summarize the current evidence on AMD-associated macular holes, and provide insights into the underlying pathophysiological mechanisms, prevalence, prognosis and surgical outcomes. Research to date suggests that macular holes can uncommonly develop in eyes with coexistent AMD, with a contributing role of tractional and degenerative component in their development and progression. Intravitreal anti vascular endothelial growth factor injections for neovascular AMD have been implicated in macular hole formation. Surgical intervention with vitrectomy and internal limiting membrane peel remains the optimal proven method for restoring vision in macular holes, however comprehensive evaluation and individualized management approaches may optimize anatomical and functional outcomes in this patient population. Recent findings underscore that there is no evidence yet of a benefit to using stem cell therapy in macular holes with coexistent AMD. This review sheds light on the postulated pathogenesis of AMD-associated macular holes, discusses practical aspects of prognostic prediction and examines appropriate management options. Current evidence needed to guide clinical practice is both limited and often contradictory, and further studies are warranted to elucidate these findings.
Christou et al. (Thu,) studied this question.
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