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P. Bhatnagar, P.K. Kaiser, S.D. Smith, D.M. Meisler, H. Lewis, J.E. Sears; Reopening of Previously Closed Macular Holes After Cataract Extraction . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4637.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the incidence of reopening of previously closed macular holes after cataract extraction.
Retrospective, interventional, consecutive case series of full thickness macular holes successfully closed by vitrectomy. For analysis, patients were divided into 4 groups based upon lens status at presentation and sequence of vitrectomy and cataract extraction: (1) pseudophakic at presentation (Prior CE), (2) cataract extraction after vitrectomy (PPV then CE), (3) no cataract extraction (PPV only), and (4) Combined vitrectomy and cataract extraction (PPV–CE combined). Patient age, lens status at presentation, stage of macular hole, chronicity of hole, surgical procedures, visual outcomes, surgical outcomes and complications were analyzed. The primary outcome, reopening of the macular hole, was evaluated using Cox proportional hazards regression. Kaplan–Meier analyses were employed to compare the outcome of reopening among the 4 groups.
The 211 cases were divided into groups as follows: (1) Prior CE, 56 eyes, (2) PPV then CE, 86 eyes, (3) PPV only, 46 eyes, and (4) PPV–CE combined, 28 eyes. Overall, 24 macular holes reopened (11%) with the greatest number (17, ##%) occurring in the PPV then CE group. In contrast, reopening occurred in 1 eye (3.6%) in the Combined PPV and CE group, 3 eyes (7.3%) in the PPV only group, and 3 eyes (5.4%) for the Prior CE group. Cox proportional hazards survival regression failed to demonstrate an association between duration of hole, use of serum, intentional peeling of ILM, or macular hole stage and reopening of a successfully closed macular hole. However, the analysis did show a 4 fold increased risk of macular hole reopening in those patients who underwent cataract extraction after successful vitrectomy (Hazards ratio: 4.38; 95% CI: 1.7 – 11.2; p=0.002). Kaplan– Meier analysis of time to failure showed significantly decreased rates of continued macular hole closure in the eyes having cataract extraction after vitrectomy when compared to eyes from the other 3 groups combined (log rank p<0.00005).
Cataract extraction when performed as a separate and sequential procedure after successful vitrectomy for macular hole may increase the risk of macular hole reopening and should be taken into account when performing this surgery.
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