Eccentric Macular Hole after Pars Plana Vitrectomy for Epiretinal Membrane Without Internal Limiting Membrane Peeling: A Case Report

Abstract

IntroductionPostoperative eccentric macular hole formation is an uncommon complication after pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling for the treatment of epiretinal membrane (ERM). We present a case of eccentric macular hole formation after PPV for ERM without ILM peeling.Case reportA 68-year-old male patient presented with ERM and visual acuity of 6/24 in his left eye. He underwent 23-gauge PPV without ILM peeling for treatment of ERM. One week postoperatively the retina was attached and the epiretinal membrane was successfully removed, while visual acuity was 6/9. One month after PPV, a single eccentric retinal hole below the macula was detected using fundoscopy and subsequently confirmed by optical coherence tomography. At this time the visual acuity was 6/9 and the patient reported no symptoms. No further intervention was attempted and at the 9-month follow-up, the visual acuity and the size of the eccentric macular hole remained stable.ConclusionEccentric macular holes can be developed after PPV even without ILM peeling and are usually managed conservatively by observation.

Spontaneous Closure of Secondary Eccentric Macular Holes Following Vitreoretinal Surgery

“…4,5 Secondary eccentric MHs following vitreous surgery for varying indications with variable outcomes have been reported in literature. [5][6][7][8][9] In this report, we present 2 cases of eccentric MHs following vitrectomy that showed an outcome different from what has been reported previously in established literature.…”

“…These include direct mechanical surgical trauma, use of toxic dyes during the surgery, peeling of the ILM itself, presence of cystoid macular edema, and contraction of the residual ILM. [5][6][7][8][9][10] Most studies on the outcomes of secondary eccentric MHs have shown the holes to remain stable and not progress to retinal detachment. 5,6,8,9 However, in both our cases, we noted spontaneous closure of the eccentric MHs occurring at 12-and 4-weeks postevolution respectively.…”

“…[5][6][7][8][9][10] Most studies on the outcomes of secondary eccentric MHs have shown the holes to remain stable and not progress to retinal detachment. 5,6,8,9 However, in both our cases, we noted spontaneous closure of the eccentric MHs occurring at 12-and 4-weeks postevolution respectively. The size of the retinal holes in both cases was ,200 mm.…”

“…These include direct mechanical surgical trauma, use of toxic dyes during the surgery, peeling of the ILM itself, presence of cystoid macular edema, and contraction of the residual ILM. 5–10…”

Effect of Laser Photocoagulation on Macular Edema Associated With Macular Holes

“…E ccentricmacular hole (MH) is a rare but established complication after pars plana vitrectomy with or without internal limiting membrane peel (PPV/ ILM) and may occur in 0.3 to 6% of cases after PPV for various macular disorders including epiretinal membrane, MH, and persistent cystoid macular edema (CME). [1][2][3] The pathophysiology of eccentric MH formation has yet to be elucidated. Proposed theories include contraction of the persistent ILM, secondary epimacular proliferation stimulated by the ILM peel, and iatrogenic traction to the retina with the forceps during membrane peeling.…”