Macular holes and endogenous electric fields A Theoretical Model Of How Electrotaxis In Retinal Glial Cells Aids In Macular Hole Closure.

Abstract

Purpose: To introduce the concept of endogenous electric fields in macular hole closure and propose them as a plausible mechanism guiding retinal glial cell migration to facilitate closure. Methods: This theoretical model reviews the current literature on electrotaxis as a well-established mechanism of cell migration in wound healing, particularly in tissues such as cornea and skin. These principles are then applied to the unique bioelectric environment of the retina, with analysis focused on Müller cells and the retinal pigment epithelium (RPE) as critical ion regulators capable of generating endogenous fields. Results: The model proposes that ionic fluxes across the RPE and Müller cells can generate EEFs sufficient to direct electrotaxis, thereby providing a plausible biological explanation for the success of diverse surgical techniques. From ILM peeling to autologous or heterologous tissue transplantation, these interventions may restore or enhance the bioelectric environment necessary for glial-mediated closure. Conclusion: Endogenous electric fields may represent a previously unrecognized but potentially central mechanism in macular hole resolution. This unifying theory illuminates the cellular drivers underlying successful closure, explains existing surgical outcomes, and may inform novel, biology-driven therapeutic strategies to improve patient care.