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M. D'Souza, V. Chaudhary, R. Devenyi, P. Kertes, W.-C. Lam; Anatomic and Functional Outcomes in Patients With Repeat Surgery for Idiopathic Full Thickness Macular Holes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2065.
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To evaluate the efficacy of re-operation in patients with persistent or recurrent idiopathic full-thickness macular hole (FTMH) after initial surgery with internal limiting membrane (ILM) peel.
Retrospective interventional consecutive case series. Four hundred and ninety one patients underwent surgery for FTMH from Jan 2003 to May 2008. Charts for all patients with macular hole surgery with ILM peel were identified and reviewed. Functional and anatomic outcome data was collected on all who had persistent or recurrent FTMH and underwent repeat surgery.
Initial surgery with ILM peel failed to achieve anatomical closure in 55 of 491 (11.2%) patients. Majority of patients who failed surgery were in the "unclosed hole" group (51/55) versus the "reopened hole" group (4/55). 40 of 55 patients opted for repeat surgery. In all cases, repeat surgery involved enlargement of ILM rhexis and long acting gas tamponade. Anatomic closure rate after the 2nd surgery was 48%. Visual acuity results for repeat surgery failed to show significant improvement in vision. If only patients who achieved anatomical closure are examined, there is a statistically significant improvement in best-corrected visual acuity during the 1-year follow-up (p = 0.015). Presence of cuff of subretinal fluid at hole margin as determined by OCT prior to re-operation is associated with increased closure rate (63.6% versus 33.3%) but this did not reach statistical significance.
Repeat macular hole surgery in patients with initial ILM peel offers a reasonable anatomical success rate as well as improvement in best-corrected visual acuity in those patients who achieve hole closure. Pre-operative OCT analysis may provide some use in identifying patients most likely to benefit from repeat surgery.
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