Results of surgery on macular holes that develop after rhegmatogenous retinal detachment

Abstract

Aims: To evaluate the characterics and surgical prognosis of macular holes that develop after rhegmatogenous retinal detachment repair.

Design: Retrospective, interventional, consecutive case series.

Methods: The case records of nine patients who developed a new full-thickness macular hole after prior RD repair were reviewed over 6 years. Optical coherence tomography (OCT) confirmed these holes. They were offered surgical repair with a median follow-up of 13.3 months (1–63 months). Main outcomes included preoperative vitreo-macular status, OCT evaluation and postoperative visual acuity.

Results: 1007 eyes underwent surgery for prior retinal detachment between August 1999 and September 2005. Nine eyes developed a full-thickness macular hole (prevalence 0.9%): five developed after scleral buckling surgery, one after pneumatic retinopexy and three after primary vitrectomy. The mean time to macular hole diagnosis after RD was 2.9 months (0.5–18). All patients underwent macular hole surgery by the same surgeon.

At 1 month, macular hole repair was noticed in eight eyes. In this group, visual acuity at a median of 11.9 months of follow-up was 20/125 (20/400 – 20/63). Three eyes had an improvement of more than three Snellen lines.

Conclusions: Macular holes developing after RD repair is a rare complication (less than 1%). Its physiopathological mechanisms are not well known. Conventional macular hole surgery including pars plana vitrectomy, inconstant internal limiting membrane delamination and long-acting gas tamponade seems to achieve to macular reattachment (89%). The visual outcome seems conditioned by the macular status noticed during the RD.