Macular Hole After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Medina, Carlos A.; Ortiz, Alberto; Relhan, Nidhi; Smiddy, William E.; Townsend, Justin H.; Flynn, Harry W.

doi:10.1097/iae.0000000000001351

Cited by 28 publications

(49 citation statements)

References 27 publications

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“…While both tangential and anteroposterior traction are thought to be central to the pathogenesis of idiopathic MH, subsequent studies using OCT have demonstrated that a predominantly anteroposterior orientation of tractional forces play a more crucial role 13 . Postoperative MH in the setting of absent vitreous, and therefore, no anteroposterior traction, however, raise questions regarding the responsible pathophysiology and underlying mechanisms 3,11 . In the present study, we examined our own experiences with this surgical complication, describing both the clinical spectrum and treatment outcomes, and have identified possible factors predictive of long-term prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Current literature describes cases of secondary MH after surgical repair of retinal detachments (RD) 8 , epiretinal membranes (ERM) 2 , vitreomacular traction syndrome (VMTS) 9 , and myopic foveoschisis 10 . These studies also document a wide combination of adjuvant techniques used during the initial vitrectomy, such as ILM peeling, scleral buckling, and pneumatic tamponade 11 . Many of the aforementioned studies also report that the vitreous was already detached prior to the primary vitrectomy 12 .…”

Section: Introductionmentioning

confidence: 96%

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Clinical characteristics, risk factors, and surgical outcomes of secondary macular hole after vitrectomy

Kang

Han

Choi

et al. 2019

Sci Rep

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Secondary macular hole(MH) formation after vitrectomy is rare and its risk factors and pathogenesis are not clearly understood. This retrospective study was conducted to identify the risk factors of this complication and assess outcomes at 2 tertiary centres. The primary outcomes were the clinical characteristics associated with development of secondary MH, which included the primary diagnosis for initial vitrectomy, features on optical coherence tomography, and adjuvant surgical techniques used during the initial surgery. Secondary outcomes included the change in best-corrected visual acuity(BCVA), clinical factors associated with the need for re-operations for MH closure and prognostic factors for the visual outcomes. Thirty-eight eyes out of 6,354 cases (incidence 0.60%) developed secondary MH after undergoing vitrectomy for various vitreoretinal disorders over an 11-year period, most frequently after initial surgery for retinal detachment(RD) (9 eyes) and secondary epiretinal membrane (6 eyes). The mean age was 57.1 years (range: 17.8–76.7), and the mean follow-up was 51.1 months (range: 6.8 to 137.6). Prior to secondary MH formation, development of ERM was the most common OCT feature (19 eyes, 50%), and no cases of cystoid macular oedema (CME) were observed. A greater proportion of eyes with secondary MH had long axial lengths (32% ≥26 mm vs 5% of eyes ≤22 mm). MH closure surgery was performed in 36 eyes and closure was achieved in 34 (success rate 94%, final BCVA 20/86), with ≥3-line visual gain in 18 cases. BCVA at MH onset (OR = 0.056, P = 0.036), BCVA at post-MH surgery month 3 (OR = 52.671, P = 0.011), and axial length ≥28 mm (OR = 28.487, P = 0.030) were associated with ≥3-line visual loss; a history of macula-off RD (OR = 27.158, P = 0.025) was associated with the need for multiple surgeries for MH closure. In conclusion, secondary MH occurs rarely but most commonly after vitrectomy for RD. Patients with axial length ≥28 mm and poor BCVA at 3 months post-operation may have limited visual prognosis; those with a history of macula-off RD may require multiple surgeries for hole closure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Clinical characteristics, risk factors, and surgical outcomes of secondary macular hole after vitrectomy

Kang

Han

Choi

et al. 2019

Sci Rep

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“…Although the MH closure rate reaches approximately 90% with the standard procedure, some cases are more challenging and display a worsened prognosis [4]. In fact, large MHs' diameters > 400 μm, chronic MHs, and secondary MHs, resulting from ocular trauma, severe myopia, retinal detachment or proliferative vitreoretinopathy, present with poor anatomical and functional outcomes [5]. In 2010, Michalewska et al introduced the inverted ILM flap technique, improving both visual acuity and closure success of large idiopathic MHs and myopic MHs [6].…”

Section: Introductionmentioning

confidence: 99%

Inverted internal limiting membrane flap technique versus complete internal limiting membrane peeling in large macular hole surgery: a comparative study

et al. 2020

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Background: To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the complete ILM removal in the treatment of large stage 4 macular hole (MH) > 400 μm and to evaluate reconstructive anatomical changes in foveal microstructure using spectral-domain optical coherence tomography. Methods: This is a retrospective, consecutive, nonrandomized comparative study of patients affected by idiopathic, myopic or traumatic stage 4 MH (minimum diameter > 400 μm) treated with 25-gauge pars-plana vitrectomy with either complete ILM peeling (n = 23, Group 1) or inverted ILM flap technique (n = 23, Group 2), between August 2016 and August 2018. Main outcomes measured were the MH closure rate assessed by spectral-domain optical coherence tomography and the best-corrected visual acuity (BCVA) at six months. Foveal microstructure reconstructive changes were evaluated using SD-OCT to determine predictive factors of postoperative BCVA. Results: Closure of MH was achieved in 16/23 cases of Group 1 (70%) and in 22/23 cases of the Group 2 (96%). Surgical failure was reported in 6 cases of Group 1 and 1 case of Group 2. The MH closure rate was significantly higher with the inverted ILM flap technique (P-value = 0.02). Average BCVA (LogMAR) changed from 1.04 ± 0.32 to 0.70 ± 0.31 in Group 1 and from 0.98 ± 0.22 to 0.45 ± 0.25 in Group 2 (P-value = 0.005) at 6 months. Improvement in BCVA (> 0.3 LogMAR units) was statistically higher in the Group 2 (P-value = 0.03). Restoration of foveal microstructure was significantly higher in the Group 2 at 6 months (52% vs 9%, P-value < 0.01). In Group 2, the integrity of the external limiting membrane at 3 months postoperatively was the only significant feature correlated with postoperative BCVA at 6 months (r = 0.562; P-Value = 0.01, forward stepwise regression analysis). Conclusion: Inverted ILM flap technique is more effective than the classic ILM peeling for the closure of large stage 4 MHs > 400 μm, improving both anatomical and functional outcomes. Early recovery of the external limiting membrane at 3 months is a positive predictive value of postoperative BCVA 6 months after inverted ILM flap technique.

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“…Medina et al [ 5 ] reported that the possible associations found in patients with MH formation after pars plana vitrectomy for RD included ERM, macular-off RD, recurrent RD, and high myopia, and several studies have reported that ERM was especially found as the cause of MH formation after vitrectomy for rRD [ 4 , 6 , 7 , 8 ]. Our study found no cases with conclusive macular-off or recurrent rRD, and only 1 case with high myopia (Case 4).…”

Section: Discussionmentioning

confidence: 99%

“…The underlying mechanism of macular hole (MH) formation is reported to be tangential vitreofoveal [ 1 ] and anteroposterior vitreofoveal traction [ 2 ]. However, MH formation in the vitrectomized eye, in which such traction does not exist, was reported in several articles [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Lee et al [ 3 ] reported that the cause of MH formation after vitrectomy was epiretinal membrane (ERM), cystoid macular edema, or high myopia and suggested that MH formation within 3 months after vitrectomy was possibly iatrogenic.…”

Section: Introductionmentioning

confidence: 99%

Full-Thickness Macular Hole Formation in the Postoperative Period After Initial Vitrectomy for Rhegmatogenous Retinal Detachment

Takashina

Watanabe

Tsuneoka

2017

Case Rep Ophthalmol

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Background and Objective: To evaluate full-thickness macular hole (MH) formation in the postoperative period after initial vitrectomy for rhegmatogenous retinal detachment (rRD). Materials and Methods: We retrospectively reviewed the medical records of 4 consecutive eyes that required additional vitrectomy for full-thickness MH between April 2013 and March 2016 after undergoing an initial vitrectomy for rRD. Results: Epiretinal membrane (ERM) was identified by preoperative optical coherence tomography or intraoperative dye staining in each case. Photocoagulation of retinal breaks prior to initial vitrectomy was performed in Cases 1, 2, and 3 (4–16 days), with yttrium-aluminum-garnet capsulotomy after cataract extraction also performed prior to the retinal break formation in Case 3. At the initial vitrectomy, there was a superior retinal break which crossed the equator in Case 2, and an intentional hole was created in Cases 1 and 4. The mean interval from the initial vitrectomy until MH formation was 27.5 ± 15.8 months. As with Case 2, the intervals in Cases 1 and 4, in which an intentional hole was created, were clearly shorter than in those in Case 3. Finally, MH closure was achieved after an additional vitrectomy (removal of the internal limiting membrane with ERM and gas tamponade) and best-corrected visual acuity improved in each case. Conclusion: ERM was identified in the cases examined in our study. The presence of an intentional hole might shorten the interval of MH formation after vitrectomy for rRD.

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Macular Hole After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Cited by 28 publications

References 27 publications

Clinical characteristics, risk factors, and surgical outcomes of secondary macular hole after vitrectomy

Clinical characteristics, risk factors, and surgical outcomes of secondary macular hole after vitrectomy

Inverted internal limiting membrane flap technique versus complete internal limiting membrane peeling in large macular hole surgery: a comparative study

Full-Thickness Macular Hole Formation in the Postoperative Period After Initial Vitrectomy for Rhegmatogenous Retinal Detachment

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