Secondary surgery after failed macular hole repair in a real-world setting – results from an international, multicenter, retrospective study

Abstract

Purpose : Although modern primary macular hole (MH) surgery has excellent closure rates, repair of persistent MHs remains challenging, and numerous surgical approaches have been reported. Given the heterogeneity of techniques, there is a need to investigate how surgeons treat failed MHs, and what the structural and functional outcomes are.

Methods : Anonymized patient records with persistent MHs after primary closure surgery were retrospectively reviewed. All eyes underwent repeat surgery and were grouped in one of three categories based on the surgical approach: 1) manipulation of the internal limiting membrane (ILM) through repeat peeling or ILM translocation, 2) tissue transplantation using amniotic membrane or autologous retina, and 3) other approaches including fibrin glue, induced macular detachment, or autologous blood.

Results : A total of 40 eyes from 40 patients undergoing secondary MH surgeries from 4 continents and 10 centers were included. The average patient age was 63 years, the average number of prior surgeries was 1.6, and 53 % were males. Manipulation of the ILM (N=15) led to MH closure in 53.3% and an improvement of best-correct visual acuity (BCVA) from 20/228 at baseline to 20/156 at month 6 after surgery; tissue transplantation (N= 14) led to MH closure in 85.7 % and an improvement of BCVA from 20/546 to 20/290. Various other approaches (N= 11) led to MH closure in 81.8 % (R² = 0.0938) and an improvement of BCVA from 20/235 to 20/84.

Conclusions : Secondary MH closure is possible using various surgical techniques with acceptable anatomical closure rates. We did not observe a meaningful difference in closure rates based on the surgical category but BCVA improved in all groups.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.