Macular Holes Associated with Diabetic Tractional Retinal Detachments

Abstract

Abstract: : Purpose To evaluate the formation and surgical treatment of full-thickness macular holes (FTMHs) in diabetic eyes secondary to tractional retinal detachments (TRDs) Methods We conducted a retrospective review of the medical records, fluorescein angiography, fundus photography, and operative findings of six patients with full-thickness macular holes and diabetic tractional retinal detachments. Those eyes with partial thickness or lamellar holes, or with macular holes that could be attributed to other etiologies including diabetic maculopathy, cystoid macular edema, and subretinal hemorrhage, were excluded. This series was obtained from 2000-2002. Each eye was treated with pars plana vitrectomy (PPV), membranectomy, Indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling, and gas/fluid exchange. Results This series included 6 patients (5 females/1 male). The patients' mean age was 57 (range 38 to 70). Four patients had insulin-dependent diabetes mellitus (IDDM) and two had non-insulin dependent diabetes mellitus (NIDDM). The mean duration of the diabetes was 17.3 years. Each patient had a macular hole that was attributed to the diabetic tractional retinal detachment. The mean pre-op BCVA (best-corrected visual acuity) was 20/267 (LogMAR = 1.125). Surgical intervention included 4 patients receiving 20% sulfur hexafluoride (SF₆) and 2 patients receiving 15% perfluoropropane (C₃F₈). The mean post-op BCVA was 20/105 (LogMAR = 0.72 ). The mean post-op follow-up duration was 7.2 months. All macular holes closed. These macular holes were of an oval morphology. Conclusions Successful closure of macular holes attributed to diabetic tractional retinal detachments can be achieved via pars plana vitrectomy, membranectomy, excision of the internal limiting membrane, and gas/fluid exchange. These macular holes are more challenging to treat surgically due to the tractional forces from the diabetic proliferative tissue. Vitrectomy with excision of proliferative membranes helps to relieve the tractional forces responsible for macular hole formation. This enables successful closure of the macular hole resulting in stabilization or improvement in visual acuity.

Keywords: macular holes • diabetic retinopathy • retinal detachment