Late reopening of successfully treated macular holes
a Department of Ophthalmology, Hôpital Lariboisière,
Université Paris VII, Paris, France, b Department of Biophysics, Hôpital Lariboisière,
Université Paris VII, Paris, France
Correspondence to: Alain Gaudric, MD, Department of Ophthalmology, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France.
Accepted for publication 1 May 1997
BACKGROUND
Most idiopathic macular holes can be
closed by a surgical procedure combining vitrectomy, posterior hyaloid
ablation, and fluid-gas exchange followed by postoperative positioning.
Reopening of closed macular holes has been reported, but its frequency
is not known. Here the incidence of reopening after successful macular hole surgery is reported.
METHODS77 consecutive cases of idiopathic
macular holes operated with autologous platelet injection between July
1993 and October 1995 were reviewed. The procedure consisted of three
port vitrectomy, posterior hyaloid removal, non-expansile fluid-gas
exchange, and autologous platelet injection followed by face down
positioning. The incidence of reopening was analysed in the cohort of
the 72 anatomical successes.
RESULTSMean follow up was 12.3 months. The
macular hole reopened in five eyes of five patients (five out of 72 patients, 6.9%), in four cases after cataract extraction. In four
cases too, an epiretinal membrane was noted, either clinically or
during reoperation, and fluorescein leakage in the macular area was
present in two cases. Three of the five cases of reopening were
reoperated and all three were anatomical successes.
CONCLUSIONLate macular hole reopening occurred in
five out of 72 patient, and in four cases after cataract surgery. The
presence of an epiretinal membrane around the hole in four of them
suggested that tractional forces were responsible for the reopening.
Reoperation, performed in three cases, again closed the macular holes.
© 1997 by British Journal of Ophthalmology
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