Purchase this article with an account.
Stuart Brian Carter, KaPo Yeung, Joseph Tseng, Kenneth Wald; Characterization of patients with retinal detachment after macular hole repair. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5087.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The purpose of the study was to understand the pre-, intra- and postoperative clinical findings of eyes that developed rhegmatogenous retinal detachment (RRD) following macular hole surgery (MHS).
A retrospective analysis of consecutive cases of MHS that developed RRD over a six year period (2009-2014) by a single surgeon (KJW) was performed. All patients had a uniform surgical approach: pars plana vitrectomy, posterior hyaloid interface (PHI) separation, internal limiting membrane peeling, inspection of the retinal periphery with scleral indentation, and gas insufflation. Any pre- or intraoperative retinal tears or precursors were treated with laser photocoagulation. Patients with RRD on postoperative examination were analyzed.
293 macular hole repairs were performed during the study period. 9 patients had postoperative RRD (3.1%). Of the 9 patients reviewed, the average age was 64 years (SD=7.2). 5/9 patients had pre-existing retinal pathology including lattice (2), peripheral retinal tufts (2), and previous retinal tear (1). 4/9 patients had intraoperative laser photocoagulation treatment for these lesions. One patient, with no visible precursor, had a mother and sister with history of bilateral RRD. The average time to detection of RRD was 52 days (range=11-180) with 6/9 patients presenting within the first 60 days. RRD location was inferior in 7/9 patients. All detachments were repaired with subsequent surgery. In patients who completed postoperative follow-up, 7/8 had documented macular hole closure via optical coherence tomography. Of 6 patients with documented pre- and postoperative visual acuities, 1 patient had loss of visual acuity while the remaining patients improved visual acuity by 2-5 Snellen lines.
RRD is a known complication of MHS. Our results suggest that a majority of these eyes have pre-existing retinal pathology or predisposition to RRD. Other findings include early postoperative onset of RRD (most within the first 2 months) and a tendency to form inferior detachments. The complication is not clearly associated with failure of macular hole closure and most cases result in favorable visual outcomes. Careful preoperative peripheral retinal examination and prophylactic treatment of precursors appears to be warranted, but cannot fully prevent this complication.
This PDF is available to Subscribers Only