Spontaneous formation and closure of full thickness macular hole in a vitrecto-mised eye : a case report

Gurung, Rajya Laxmi

doi:10.3126/nepjoph.v9i2.19270

Cited by 1 publication

(3 citation statements)

References 6 publications

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“…Observation of MH and monitoring hoping for self-closure of the MH is a strategy, and there have been reports of spontaneous closure of the MH with improvement in BCVA. 8 In our study, case 5 demonstrated OCT features of attempted spontaneous hole closure while waiting for MH surgery, as seen in Figure 9 . Lastly, we should mention that topical treatment of secondary MH has been reported with anatomical success and improvement in vision.…”

Section: Discussion and Reviewmentioning

confidence: 50%

“…Another mechanism of MH formation is iatrogenic trauma during vitrectomy surgery. 8 Possible causes of iatrogenic trauma include direct instrument contact, traction induced MH during ILM or ERM peeling, and the direct impact of a jet of high-velocity air or infusion fluid on the macula. A replay of the surgical video, if available, will reveal any unrecognized physical impact on the macula.…”

Section: Discussion and Reviewmentioning

confidence: 99%

“…The causative mechanisms that have been associated with post vitrectomy MH formation include tangential traction from the residual perifoveal vitreous cortex, 6 cystoid degeneration, 7 and intraoperative (iatrogenic) trauma. 8 Epiretinal membranes (ERM) are present in several cases, suggesting a causal association. 9 Indication for the primary vitrectomy reported in the literature include rhegmatogenous retinal detachment (RRD), ERM surgery, macular edema, diabetic vitrectomy, vitreous hemorrhage removal, and pre-insertion of Baerveldt glaucoma implant amongst others.…”

Section: Introductionmentioning

confidence: 99%

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Secondary Macular Holes Post Pars Plana Vitrectomy

Okonkwo¹,

Akanbi²,

Agweye

2022

IMCRJ

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Purpose To report incidence, clinical presentation, and treatment outcome of full-thickness macular hole (FTMHs) diagnosed post pars plana vitrectomy. Methods We retrospectively reviewed the demographics, best-corrected visual acuity (BCVA), indication for the primary vitrectomy, time to diagnose the secondary FTMH, optical coherence tomographic (OCT) appearance, and treatment outcome of FTMHs, occurring after vitrectomy performed between January 2019 and December 2020. Results Six of 523 vitrectomized eyes developed FTMHs, an incidence of 1.1%. There were five females and one male, mean age of 56.5 years (range 37–85). The indication for primary vitrectomy was rhegmatogenous retinal detachment (RRD) in three eyes, one eye each for sub internal limiting membrane hemorrhage from a ruptured macroaneurysm, vitreous hemorrhage from polypoidal choroidal vasculopathy (PCV), and pre-insertion of Ahmed glaucoma drainage device (GDD). FTMHs occurred within one week to three months after vitrectomy (time from primary vitrectomy to the identification of the secondary MH was a mean of 1.03 months). Mean BCVA in all six MH eyes was log MAR 0.9 (Snellen: 6/54). Anatomical closure was achieved after one surgery in three eyes, two surgeries in 1 eye, after photodynamic therapy (PDT) in the PCV eye, and one patient declined surgery. The mean BCVA in the four surgically closed MH eyes improved marginally from log MAR 0.82 (Snellen: 6/38) to log MAR 0.72 (Snellen: 6/30), mean follow-up 7.6 months. Conclusion Post-vitrectomy FTMH is rare, and RRD was the commonest indication for initial vitrectomy. We observed that all secondary MHs were closed successfully using the inverted internal limiting membrane (ILM) flap technique with limited improvement in vision. The visual outcome of these secondary MHs trails behind that of idiopathic MHs.

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Section: Discussion and Reviewmentioning

confidence: 50%

Section: Discussion and Reviewmentioning

confidence: 99%