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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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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.
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.
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.
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.
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