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.Idiopathic macular hole is a well-known macular disease. Its origin has been attributed to tangential vitreofoveal traction responsible of centrofoveal defect.1 2 These data have been confirmed by optical coherence tomography (OCT). Thus, posterior vitreous detachment seems to be a protective factor to macular hole development. However, the occurrence of rhegmatogenous retinal detachment (RD) is often secondary to posterior vitreous detachment.Macular holes are an uncommon cause of rhegmatogenous RDs but can occur secondary to a retinal detachment associated with peripheral breaks.The condition has been described after scleral buckling, 4 pneumatic retinopexy 5 6 and vitrectomy. Many surgeons have attempted closure of such macular holes, but the results of surgery have not been widely published. We describe the characteristics of nine patients with a macular hole that develops after successful rhegmatogenous retinal detachment surgery. All patients underwent surgery to close the macular hole. METHODSThe medical records of all patients who had undergone retinal detachment surgery were reviewed from August 1999 to September 2005 retrospectively (1007 eyes). Following surgery, nine eyes developed a full-thickness macular hole (0.9%) as confirmed by OCT (OCT 3, StratusH, Carl Zeiss Meditec, Dublin, CA). All patients were offered surgery repair of their macular hole.The data...

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OBJECTIVEDiabetic retinopathy is associated with progressive retinal capillary activation and proliferation, leading to vision impairment and blindness. Microparticles are submicron membrane vesicles with biological activities, released following cell activation or apoptosis. We tested the hypothesis that proangiogenic microparticles accumulate in vitreous fluid in diabetic retinopathy.RESEARCH DESIGN AND METHODSLevels and cellular origin of vitreous and plasma microparticles from control (n = 26) and diabetic (n = 104) patients were analyzed by flow cytometry, and their proangiogenic activity was assessed by in vitro thymidine incorporation and neovessel formation in subcutaneous Matrigel plugs in mice.RESULTSMicroparticles of endothelial, platelet, photoreceptor, and microglial origin were identified in vitreous samples. Levels of photoreceptor and microglial microparticles were undetectable in plasmas but were comparable in diabetic and control vitreous samples. Vitreous platelet and endothelial microparticles levels were increased in diabetic patients and decreased following panretinal laser photocoagulation or intravitreal antivascular endothelial growth factor injection in proliferative diabetic retinopathy (PDR). The ratio of vitreous to plasma microparticle levels was calculated to estimate local formation versus potential plasma leakage. In PDR, the endothelial microparticles ratio—but not that for platelet—was greater than 1.0, indicating local formation of endothelial microparticles from retinal vessels and permeation of platelet microparticles from plasma. Isolated vitreous microparticles stimulated by 1.6-fold endothelial proliferation and increased new vessel formation in mice.CONCLUSIONSThe present study demonstrates that vitreous fluid contains shed membrane microparticles of endothelial, platelet, and retinal origin. Vitreous microparticles levels are increased in patients with diabetic retinopathy, where they could contribute to disease progression.