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Haruhiko Yamada; Surgical outcome of macular holes formed after vitrectomy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1149.
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Generally, it is rare to experience formation of a macular hole after a vitrectomy in cases with a non-macular hole. This study investigated the surgical outcome of macular holes formed after vitrectomy.
We carried out a retrospective review of the clinical records of cases with macular holes who received a vitrectomy at Kansai Medical University and Yamada Eye Clinic during the period January 2006 to November 2013. From these cases, we recruited those in which the macular hole formed after vitrectomy. All the recruited cases had a vitrectomy and gas or air tamponade with complete removal of the internal limiting membrane (ILM) as treatment for the macular hole. We investigated the type of original disease that necessitated the primary vitrectomy and also the method used in the procedure. We then compared the best corrected visual acuity (BCVA) at the first visit, after the primary vitrectomy, at macular hole onset, 3 months after macular hole surgery, and at the last visit.
Formation of a macular hole after vitrectomy occurred in 14 cases (8 males and 6 females; mean age 63.2 yr, range 42- 79 yr). The mean period after the primary vitrectomy to macular hole onset was 17.6 mth, while the mean observation period after macular hole surgery was 25.7 mth. The original disease included 5 cases of rhegmatogenous retinal detachment, 3 cases of diabetic macular edema, 3 cases of epi-retinal membrane, and 1 case of proliferative vitreoretinopathy, proliferative diabetic retinopathy, or macular retinoschisis. Ten of the 14 eyes were operated without removing the ILM at the primary vitrectomy. In two cases, although the ILM was removed in the primary vitrectomy, the membrane was found to still be present during macular hole surgery. The macula hole was closed successfully in all cases after macular hole surgery. The BCVA after the primary vitrectomy (p=0.021) and final visit (p=0.038) was statistically better than that measured at the onset of the macular hole.
Surgery for macular holes which formed after vitrectomy achieved anatomical success, but compared to surgery for idiopathic macular holes, visual outcome appeared to be poor following surgery for macular holes that remained after a vitrectomy. However, the BCVA improved after surgery. A residual ILM may play a role in forming macular holes after vitrectomy.
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