Abstract
Purpose :
Although infrequent, reoperations for recurrent or persistent full thickness macular holes have been shown to have a lower success rate based on anatomic and functional outcomes. The optimal approach to these recurrent or persistent macular hole cases who have already undergone removal of the posterior hyaloid and primary ILM removal remains under active investigation. Given the variety of surgical approaches utilized around the world, there is a need for a relatively large series to demonstrate real world visual compared to anatomic outcomes after surgery for recurrent macular holes alone. Based on the multitude of published and successful surgical techniques, a direct comparison of approaches was undertaken.
Methods :
Clinical charts of all patients who underwent recurrent macular hole surgery between 2010 and 2020 were reviewed to identify appropriate patients. Operative notes were reviewed for secondary vitrectomy procedures and the surgical technique was recorded. Particular attention was paid to phakic status and whether the internal limiting membrane was removed at the time of primary macular hole repair. Best corrected visual acuity (BCVA) was obtained at 3 months and 6 months post operatively. OCT measurements were reviewed to obtain average macular hole thickness. Eyes were excluded who carried a diagnosis of pathologic myopia (spherical equivalent greater than -8), central retinal vein occlusion, or a history of ocular trauma. All eyes in whom a macula hole was identified along with a retinal detachment were excluded for concurrent cases.
Results :
29 patients were identified to have undergone surgery for recurrent macular hole with complete followup. Patient demographics included a mean age 66.3±17. 16 patients received ILM flap, 4 patients underwent macular amniotic membrane graft, 2 macular redetachment, 7 use of silicone oil tamponade, and 5 a combination of these techniques. Mean BCVA at baseline was 20/125 and remained at 20/125 equivalent at 3 months. At 6 months the vision had declined to 20/160. The closure rate with all techniques was 81.8% after repeat surgery.
Conclusions :
Although anatomic success was achieved in the majority of cases, visual improvement did not always correlate. Additional work is needed to identify better vision salvaging techniques in surgery for recurrent or persistent macular holes.
This is a 2021 ARVO Annual Meeting abstract.