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A. Rubinstein, A. Shaikh, L. Benjamin, R. Bates; Iatrogenic Eccentric Full Thickness Macular Holes Following Vitrectomy with ILM Peeling for Idiopathic Macular Holes . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3035.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane for idiopathic macular holes. Methods: Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the internal limiting membrane for idiopathic macular holes from 1996 – 2001. Four patients were found to have eccentric iatrogenic macular holes post-operatively. Optical coherence tomography was used to evaluate these holes. Results: The idiopathic macular holes were graded stage II to IV pre-operatively with visual acuities from 6/18 to 6/60. All patients had surgery within six months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the internal limiting membrane, injection of platelets (0.1ml) and gas tamponade with SF6 20%. Post-operatively the patients postured strictly face down for ten days. Follow up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted post-operatively. The holes were located between 4 and 6 o’clock in three patients and at 12 o’clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up. Conclusions: Vitrectomy with ILM peeling and gas tamponade is a commonly performed procedure for idiopathic macular holes. Reported complications include cataract, peripheral retinal breaks, retinal detachment, peripheral field defects, endophthalmitis and raised intraocular pressure. To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are aymptomatic, have not required any treatment and not caused any complications in up to 6 years of follow-up.
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