June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Macular Hole Formation after Vitrectomy for Rhegmatogenous Retinal Detachment – Potential Risk Factors and Surgical Outcomes
Author Affiliations & Notes
  • John Carey Fitzpatrick
    Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Wendy Xie
    Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Shriji Patel
    Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Akshay Thomas
    Ophthalmology, Tennessee Retina, Nashville, Tennessee, United States
  • Avni Finn
    Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Footnotes
    Commercial Relationships   John Fitzpatrick None; Wendy Xie None; Shriji Patel None; Akshay Thomas None; Avni Finn Iveric Bio, Code C (Consultant/Contractor), Genentech, Code C (Consultant/Contractor), Alimera, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor), Eyepoint, Code C (Consultant/Contractor)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3648. doi:
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      John Carey Fitzpatrick, Wendy Xie, Shriji Patel, Akshay Thomas, Avni Finn; Macular Hole Formation after Vitrectomy for Rhegmatogenous Retinal Detachment – Potential Risk Factors and Surgical Outcomes. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3648.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Macular hole (MH) formation in vitrectomized eyes is rare and the underlying pathophysiology for hole formation after vitrectomy is not well understood. The purpose of this study was to characterize potential risk factors for hole formation in vitrectomized eyes after initial pars plana vitrectomy (PPV).

Methods : A retrospective chart review was performed in patients from two practices who underwent PPV for retinal detachment. Cases that developed a MH after PPV were identified. Demographic data as well as a history of diabetes, hypertension, high myopia, posterior vitreous detachment, lens status, history of intravitreal injections, and specifics of the surgery including type of tamponade were recorded. Patients that underwent PPV for any other indication including ERM, dislocated lens, vitreous opacities were excluded as were those with MH at time of initial PPV, and those that developed lamellar holes.

Results : 18 cases of MH formation after initial PPV for RRD between December 2017 and November 2022 were identified. The cohort consisted of 11 females and 7 males with an average age of 61.89 SD +/- 11.75. 1 patient was diabetic, 4 were hypertensive, and 1 had high myopia. 7 of the eyes were phakic at thime of initial PPV and 11 were pseudophakic. Only 8 eyes (44%) had a documented complete PVD prior to initial vitrectomy. 14 eyes (78%) were macula off while 4 were macula on. 10 eyes had a single break and 8 had multiple breaks.

Of the 18 eyes 89% (16 eyes) had single surgery anatomical success after initial PPV and 2 eyes needed repeat surgery surgery. 14/18 eyes underwent subsequent surgery with PPV/ILM peeling for MH repair. Anatomical closure of MH was achieved in all 14 eyes. Average duration to macular hole formation after vitrectomy was 377 days. After macular hole repair patients gained an average of 1.55 ETDRS letters at 1 year post operatively compared to pre-operative visual acuity measurements.

Conclusions : MH development after PPV is a rare occurrence and the pathologic mechanism is still unknown; risk factors may include macula off RRD and lack of a complete PVD at the time of retinal detachment. Patients who underwent secondary MH repair after RRD may still have good final anatomic outcomes and visual acuity.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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