Secondary Surgery in Eyes with Failed Primary Vitrectomy for Idiopathic Macular Hole

Abstract

Purpose : Few data exists on unclosed idiopathic macular holes (MH) after first surgery. We performed a retrospective clinical observational study to investigate the anatomical and functional outcomes of eyes after failed primary surgery for idiopathic MH.

Methods : Unclosed MH after first surgery were identified from a cohort of patients operated for MH between 2014 and 2018 at CHU de Québec – Université Laval (Quebec). Clinical and anatomical features of patients with MH were collected. The main outcomes were MH non-closure rate after the primary and secondary surgery, best-corrected visual acuity (BCVA) with ETDRS scale and MH size of eyes with failed primary surgery at baseline, 3, and 12 months after the secondary surgery.

Results : In our cohort of 1085 patients, we identified 22 patients with failed primary surgery in which 20 had revision surgery. The non-closure rate of MH after first surgery was 2,4% and 15% after the revision surgery. At the baseline, patients with failed primary surgery had MH size of 665 ± 226 μm. MH size after failed primary surgery was 607 ± 162 μm and one month after the revision surgery 546 ± 156 μm for the three unclosed MH. Moreover, mean changes between visual acuity at baseline and after the revision surgery for closed MH at 3 and 12 months were 17,1 ± 25,3 letters and 17,7 ± 15,1 letters. The average final BCVA for closed MH after the revision surgery was 44,1 ± 26,7 letters. The tamponade used for the secondary surgery in closed MH was 88% (15/17) C3F8 and 12% (2/17) of silicone. The revision surgery techniques employed were at 70% (12/17) conventional technique with peeling of remnant of ILM, 12% (2/17) changing tamponade, 12% (2/17) inverted FLAP technique (done with remnant of ILM flap), and 6% (1/17) internal limiting membrane transfer (Free Flap). For unclosed MH after revision surgery (3 eyes), tamponade used for the secondary surgery was C3F8 in all eyes, and the revision surgery technique was conventional technique with peeling of remnant of ILM (1 eye), changing tamponade (1 eye), and internal limiting membrane transfer (Free Flap) (1 eye).

Conclusions : The success rate of revision surgery (using different techniques) in eyes with unclosed MH is 85%. After successful revision surgery, eyes can show an improvement in visual acuity and macular hole size.

This is a 2020 ARVO Annual Meeting abstract.