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Matthew A. Cunningham, Ryan M. Tarantola, James C. Folk, Elliott H. Sohn, H. Culver Boldt, Jordan A. Graff, Korianne Elkins, Stephen R. Russell, Vinit B. Mahajan; Macular Hole Closure in Combined Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3773.
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This study reviewed the incidence and closure rate of fullthickness macular holes (MH) in cases associated with concomitant rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy.
A retrospective consecutive case series was reviewed of all patients undergoing surgical repair of a RRD at a University practice, from 2007-2011. Patients requiring simultaneous closure of a macular hole were identified. The primary outcome measure was macular hole closure rate after a single surgery. The secondary outcomes were lines of improvement on a Snellen visual acuity chart and retinal re-attachment rate. Proliferative vitreoretinopathy (PVR) was also evaluated. A minimum follow-up duration of 3 months was required.
There were 607 RRD cases identified, of which 95 (15.7%) had a component of PVR. The incidence of concomitant MHs in RRD cases was 1.3% (8/607). There were 5 males and 3 females, and the mean age of patients was 55.0 ± 20.81 years (range, 13 - 81). A 20-gauge vitrectomy system was used for repair in 5/8 cases, and the other 3 using a 23-gauge system. The mean post-operative follow-up duration of 7.75 ± 4.53 months (range, 4 - 15 months).All 8 eyes had a primary break that was distinct from the macular hole. PVR was present at the time of primary repair in 5/8 (62.5%) cases. Of the 95 RRDs with PVR, 5 had a macular hole and of the 512 RRDs without PVR, 3 had a macular hole. The p value from a 2-tailed Fisher's exact test examining the association between the presence of PVR and the presence of a macular hole was 0.0032 indicating a very significant association.The internal limiting membrane was peeled in 4/8 cases. MH closure was achieved in 7/8 (88%) cases, after a single surgery. Final retinal reattachment rate was 100% after 1 operation in these 8 cases. Mean follow-up duration was 7.75 ± 4.53 months (range, 4 - 15 months). The mean preoperative visual acuity was 2.54±0.674 logMAR units and mean postoperative visual acuity was significantly improved to 1.298±1.06 logMAR units (p=0.00344). Overall, a visual acuity of 20/125 or better was achieved in 5 patients (62.5%), and 7/8 patients had improvement in visual acuity at the final post-operative visit.
Macular holes combined with rhegmatogenous retinal detachments are infrequent, however good anatomic results can be achieved following a, simultaneous repair utilizing either a 20 or 23 gauge vitrectomy system. Proliferative vitreoretinopathy may be more frequently encountered in this particular subset of retinal detachments.
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