April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Surgical versus Medical Management of the Recurrent Macular Hole with Cystoid Macular Edema
Author Affiliations & Notes
  • Ross B Chod
    Ophthalmology, St. Louis University Eye Institute, Clayton, MO
  • Levent Akduman
    Ophthalmology, St. Louis University Eye Institute, Clayton, MO
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 320. doi:
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      Ross B Chod, Levent Akduman; Surgical versus Medical Management of the Recurrent Macular Hole with Cystoid Macular Edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):320.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

We report outcomes of management in 2 eyes with recurrent macular hole presenting with cystoid macular edema (CME). One eye was managed with repeat pars plana vitrectomy (PPV), internal limiting membrane (ILM) peel and C3F8 tamponade, the other was managed with periocular triamcinolone acetonide injections alone.

 
Methods
 

Two patients, a 65 year old woman (Patient A) and a 71 year old man (Patient B), each with a history of a surgically managed and previously closed full thickness macular hole were found to have a recurrent macular hole with CME in their previously treated eye. Patient A presented with best corrected visual acuity (BCVA) of 20/50 in the affected eye, and underwent repeat surgical repair (PPV, ILM peel, C3F8 tamponade and periocular triamcinolone acetonide injection). Patient B presented with BCVA of 20/70 in the affected eye and non-operative management with serial periocular triamcinolone acetonide injections was undertaken.

 
Results
 

Patient A: 3 months after repeat surgical repair, BCVA of the treated eye remained 20/50 with closure of the macular hole confirmed by optical coherence tomography (OCT). Foveal contour was restored despite mild remaining CME. Patient B received monthly periocular triamcinolone acetonide injections over a 3 month period. BCVA of the treated eye improved to 20/25 with closure of the macular hole confirmed by OCT. Foveal contour was restored and there was no evidence of continued CME.

 
Conclusions
 

While treatment of the recurrent macular hole is classically surgical in nature, regardless of associated CME, non-operative management is not well studied. Medical management, including periocular triamcinolone acetonide injections, might be considered in the treatment of the recurrent macular hole with CME. The best management technique for the recurrent macular hole with CME warrants further exploration.

 
 
Top Left: Recurrent macular hole of Patient A prior to surgical repair. Top Right: Closed macular hole of Patient A at 3 month follow up visit showing mild CME. Bottom Left: Recurrent macular hole of Patient B prior to serial periocular triamcinolone acetonide injections. Bottom Right: Closed macular hole of Patient B after serial periocular triamcinolone acetonide injections.
 
Top Left: Recurrent macular hole of Patient A prior to surgical repair. Top Right: Closed macular hole of Patient A at 3 month follow up visit showing mild CME. Bottom Left: Recurrent macular hole of Patient B prior to serial periocular triamcinolone acetonide injections. Bottom Right: Closed macular hole of Patient B after serial periocular triamcinolone acetonide injections.
 
Keywords: 585 macula/fovea • 688 retina  
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