Combined or sequential surgery for management of rhegmatogenous retinal detachment with macular holes

To describe the anatomical success and visual outcome in patients with rhegmatogenous retinal detachment and coexisting macular holes using two different management strategies.

Nonrandomized, prospective interventional case series where patients either had combined surgery, i.e., vitrectomy, internal limiting membrane peel, retinopexy to the peripheral breaks, and gas tamponade; or sequential, i.e., vitrectomy, retinopexy to the peripheral breaks, and gas tamponade with macular hole surgery if indicated, as a secondary procedure.

Five patients (Group 1) had combined surgery and 7 (Group 2) had sequential treatment. All retinas were reattached irrespective of surgical approach. In Group 1, best-corrected visual acuity improved in all patients from 1.8/60 to 9.2/60 Snellen (P = 0.06). In Group 2, there was improvement in best-corrected visual acuity in all patients from 3.3/60 to 12.9/60 Snellen (P = 0.05). After comparison of the logarithm of the minimum angle of resolution, postoperative best-corrected visual acuity improvement was not significantly different between both groups (P = 0.68).

The results of this study suggest that good anatomic and visual outcome can be achieved using either approach. Visual acuity improved in all patients from both groups. In sequential surgery some of the macular holes may close spontaneously. However, combined surgery offers the clinical and cost benefit of a single procedure.