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RA Pecoraro, E Petrela, BF Godley, AM Khorrami; Idiopathic Macular Hole Following Silicone Oil Placement for Rhegmatogenous Retinal Detachment . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2474.
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Purpose: To present a unique case of idiopathic macular hole developing with silicone oil present in posterior chamber following pars plana vitrectomy and scleral buckle surgery for rhegmatogenous retinal detachment. Method: A 43 year old woman presented with blurred vision OD for five days. Best corrected VA was count finger vision OD and 20/20 OS. Fundoscopy showed a temporal rhegmatogenous retinal detachment with macula completely elevated, lattice degeneration, and proliferative vitreoretinopathy with three round holes in the temporal peripheral retina OD. She underwent pars plana vitrectomy, scleral buckle, focal endolaser and gas-fluid exchange OD without complication. Postoperatively she developed proliferative vitreoretinopathy with re-detached retina. Further repair included pars plana vitrectomy, removal of proliferative vitreoretinopathy membrane and silicone oil placement. Results: After one month, with silicone oil in place, she formed a full thickness macular hole (fig 1). Silicone oil was removed and gas-fluid exchange was performed for the right eye with final VA of 20/200. Conclusion: This is the first report of macular hole formation after retinal detachment repair with silicone oil present in the posterior chamber. This adds new evidence suggesting a mechanism other than those indicating tractional vitreomacular forces1,3,4, where a degenerative process independent of the cortical vitreous is responsible for atypical macular holes2. References: 1. Smiddy, WE. Atypical presentation of macular holes. Arch Ophth 1993;111:626. 2. Lipham WJ, Smiddy, WE. Idiopathic Macular Hole Following Vitrectomy: Implications for Pathogenesis. Ophth Surgery & Lasers 1997;28:633. 3. McDonnell PJ, Fine SL, Hillis AL. Clinical features of idiopathic macular cysts & holes. Am J Ophth 1982;93:777. 4. Johnson RN, Gass JDM. Idiopathic macular holes: observations, stages of formation & implications for surgical intervention. Ophth1988;95:917. View OriginalDownload SlideView OriginalDownload Slide
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