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S.D. Adrean, J.L. Gasperini, D. Eliott; Macular Hole Formation in Patients With Previous Vitrectomy Surgery . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5198.
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To examine the results in a series of patients who underwent vitrectomy for a variety of causes and post–operatively developed a full–thickness macular hole. The patients then underwent surgical treatment for their macular hole as well as any associated retinal conditions.
A retrospective study was performed on eleven eyes that developed a macular hole after undergoing vitrectomy. The data that was collected included patient age, previous surgery, fundus photography, fluorescein angiography, optical coherence tomography, surgical intervention, subsequent surgeries, anatomic status of the macular hole, and pre–operative and post–operative visual acuity.
Initial diagnoses included five patients with proliferative diabetic retinopathy, three patients with rhegmatogenous retinal detachment, two patients with epiretinal membrane, and one patient with acute retinal necrosis. The median time between the vitrectomy surgery and development of a macular hole was 8.5 months (6 weeks to 24 months). In addition to the macular hole, six patients developed a retinal detachment with proliferative vitreoretinopathy and five patients had an epiretinal membrane. The macular hole was initially closed in all eleven patients, but two holes re–opened in the post–operative period (6 months and 3.5 years). The average visual improvement was not significant with 0.9 lines gained at 6 months and 0.6 lines gained at the final post–operative visit. Two patients experienced greater than 3 lines of improvement in visual acuity at the six month post–operative exam.
Patients that develop post–operative macular holes after previous vitrectomy surgery had anatomic success; however, the visual outcome was poor. All eleven patients had membrane proliferation that contributed to their macular hole formation. Most of these patients had additional retinal conditions associated with a poor prognosis such as macular ischemia in diabetic patients and recurrent retinal detachment in patients with proliferative vitreoretinopathy. Patients who develop a macular hole after vitrectomy surgery have a particularly guarded prognosis.
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