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Neha Sharma, Christian Akotoye, Resya Chandra Sastry, Anna K. Wu, Aleksandra Rachitskaya, Rishi P Singh; Macular Holes in Patients with Tractional Retinal Detachments due to Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2215 – F0278.
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© ARVO (1962-2015); The Authors (2016-present)
Macular holes (MH) can be seen in patients with tractional retinal detachment (TRD) and proliferative diabetic retinopathy (PDR). However, there is a paucity of literature examining the characteristics of these macular holes and the visual outcomes after surgical intervention. This study aimed to characterize the features of TRD MHs in PDR patients, the rate of MH closure following surgical intervention, and the preoperative and intraoperative factors affecting hole closure and visual outcomes.
A retrospective chart review was conducted for adults diagnosed with a MH secondary to TRD who underwent pars plana vitrectomy (PPV) surgery at Cole Eye Institute between January 2015 and August 2021. Collected variables include patient demographics, procedure performed, rate of MH closure, visual acuity (VA) and OCT biomarkers at time of diagnosis and post-operatively at 3, 6, and 12 months. Fisher’s exact test, paired t-test, and p=0.05 were used for statistical analysis.
The final cohort consisted of 11 patients and 11 eyes (8 females, average age of 57.6 years old) who developed a MH secondary to TRD. The mean HbA1c was 8.35%. Five MHs (45.5%) were associated with subretinal fluid, 5 (45.5%) were associated with vitreomacular traction, and 2 (18.2%) were associated with epiretinal membrane. Average MH size was 383.1 μm. During PPV, 12 (85.7%) patients underwent concurrent procedures, including internal limiting membrane (ILM) peeling (2, 18.2%) and/or phacoemulsification and intraocular lens placement (7, 63.6%). Tamponade choice included C3F8 gas for most patients (n=7; 63.6%), air for 1 (9.1%), SF6 gas for 1 (9.1%), and silicone oil for 2 (18.2%). Nine patients (81.8%) achieved MH closure 3 months after surgery. One (9.1%) achieved MH closure after a singular re-operation. There was borderline significance between presence of concurrent procedure and successful MH closure (p=0.0545), and no significance between use of long-acting (C3F8) tamponade and successful MH closure at 3 months (p=0.4909). The mean VA at baseline and 12 months was 1.197 logMAR (20/315) and 0.981 logMAR (20/191), respectively (p=0.185).
This study showed that the majority (81.8%) of repaired MHs secondary to TRD remained closed at the 3-month follow-up without further re-operation. Despite closure, the long-term visual outcomes in patients with TRD macular holes are limited.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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