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Surgical treatment of macular holes with multiple recurrences
1Retina Specialists, Baltimore, Maryland, USA.
Purpose:
To evaluate the results of a third macular hole surgery in eyes with recurrent macular holes and two prior macular hole surgeries.
Design:
Retrospective consecutive noncomparative case series.
Participants:
Sixteen eyes of sixteen patients with two prior macular hole surgeries with recurrent macular hole.
Intervention:
A third vitreous surgery was performed in each eye using a long-acting gas bubble.
Main Outcome Measure:
Closure of the macular hole and change in visual acuity.
Results:
The macular hole was closed in 12 of 16 eyes (75%) at 3 months after the third surgery. Visual acuity improved 2 or more Snellen lines in 9 of 16 eyes (56%), and 5 of 16 eyes (31%) achieved 20/40 or better vision. Six eyes (37.5%) had cataract surgery after the third macular hole surgery, and visual acuity results were similar in eyes with or without cataract surgery. Successful closure of the macular hole improved the visual acuity from 20/80 -1 to 20/50 +1 (P < 0.001). Eyes in which one of the previous surgeries had been temporarily successful in closing the macular hole improved from a mean of 20/80 to 20/40 (P = 0.003). Eyes in which both prior macular hole surgeries had been primary failures had minimal benefit with a preoperative visual acuity of 20/100 +1 and a postoperative visual acuity of 20/100 +2 (P = 0.67).
Conclusions:
Repeat macular hole surgery should be considered in eyes with recurrent macular holes and two prior surgeries when the macular hole was temporarily closed by at least one of the two previous surgeries. Successful closure of a macular hole in such cases usually results in significant visual acuity improvement.