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A.G. Sharma, K. Rezai, D. Eliott; Macular Holes in Patients Undergoing Diabetic Vitrectomy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1964.
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Purpose: To study the outcome of macular holes in patients with coexisting proliferative diabetic retinopathy who required vitrectomy surgery for complications of their diabetic retinopathy. Methods: This is a retrospective study of patients who underwent diabetic vitrectomy and were noted to have a coexisting macular hole by one vitreoretinal surgeon at the Kresge Eye Institute between 1995 and 2001. The preoperative characteristics, pathophysiology of macular hole formation, surgical procedure, and final visual and anatomic outcome were analyzed. Patients were followed for a minimum of three months. Results: Medical records of 303 consecutive patients who required vitrectomy surgery for proliferative diabetic retinopathy were reviewed. Fifteen of these cases had a full thickness macular hole noted preoperatively or intraoperatively. Three of the cases were reoperations (macular hole not present during primary procedure). In the twelve patients who underwent primary vitrectomy surgery, all had macular vitreous attachment. All 15 patients had extensive fibrous proliferation with areas of severe traction. None of the patients had preexisting retinal holes other than the macular hole. Closure of the macular hole was achieved in fourteen patients. Half of the patients experienced visual improvement after surgery but the visual outcome was poor. Conclusions: Although the majority of macular holes could be successfully closed, the visual prognosis of patients with complicated proliferative diabetic retinopathy who develop macular holes is guarded. The poor visual outcome in these patients is most likely due to ischemia and chronic traction induced by the posterior hyaloid and/or fibrovascular membranes.
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