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Rebecca Kim, Yu Cheol Kim, Kwang-Soo Kim; Macular hole formation after vitrectomy ; Preventable?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3319.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the secondary macular hole formation after vitrectomy and to know the preventability
A retrospective review of 27 patients (28 eyes) who had secondary macular hole formation after vitrectomy. Age, sex, best-corrected visual acuity (BCVA) before and after primary vitrectomy, operation methods, duration between the vitrectomy and the secondary macular hole surgery, the causes of the primary vitrectomy, preoperative and postoperative macular findings with optical coherence tomography (OCT) and fundus examination, and BCVA before and after macular hole surgery were recorded.
Of 28 eyes which had undergone vitrectomy, 12 eyes had proliferative diabetic retinopathy, 6 eyes had rhegmatogenous retinal detachment, 2 eyes had branch retinal vein occlusion, 3 eyes had age-related macular degeneration, and 5 eyes had trauma such as eyeball rupture or intraocular foreign body. Mean duration between primary vitrectomy and macular hole formation was 20.4 months (4 days-115 months). The estimated causes of macular hole formation included cystoid macular edema (CME) (n=13), thinning of macula (n=6), thickening of internal limiting membrane (ILM) and/or recurrence of preretinal membrane (PRM) (n=7), recurrence of subretinal hemorrhage (n=1) and macular damage during primary vitrectomy (n=2). Macular holes were closed successfully with additional surgical procedures except 1 eye with CME after primary vitrectomy. Final BCVA after macular hole surgery decreased when compared with BCVA before macular hole formation except 7 eyes (25%) and macular hole related with CME showed the worst visual prognosis
Secondary macular hole formations may be occurred from sustained CME, macular thinning and tangential traction due to thickening of ILM and/or recurrence of PRM after primary vitrectomy. Secondary macular holes had poor visual outcome in comparing to idiopathic macular holes. Therefore close observation of vulnerable macula and additional surgical maneuver in proper time after primary vitrectomy are necessary for preventing secondary macular hole formation. In addition, we have to take effort to avoid excessive tractional force to macula not to make iatrogenic damage during removal of PRM.
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