Postoperative eccentric macular holes after vitrectomy and internal limiting membrane peeling

Area of Science:

• Ophthalmology
• Retinal Surgery
• Macular Pathology

Background:

• Vitrectomy with internal limiting membrane (ILM) peeling is a common treatment for macular pathology.
• Postoperative complications, though rare, warrant thorough investigation.

Purpose of the Study:

• To describe the incidence, clinical characteristics, and outcomes of eccentric macular holes (EMHs) after vitrectomy and ILM peeling.
• To discuss the potential pathogenesis of these postoperative holes.

Main Methods:

• Retrospective, noncomparative case series of 198 patients undergoing vitrectomy and ILM peeling.
• Analysis of five patients who developed EMHs postoperatively between 2008 and 2015.

Main Results:

• Five patients (2.5%) developed full-thickness EMHs postoperatively.
• Hole characteristics varied in number (1-4), size (mean 584 μm), and timing (mean 27.7 weeks post-op).
• Final visual acuity ranged from counting fingers to 20/25; holes distant from the fovea had better acuity. No complications or further interventions were needed.

Conclusions:

• Postoperative EMHs after vitrectomy and ILM peeling are variable but generally stable and non-complicating.
• Pathogenesis may involve contraction of residual ILM or secondary epimacular proliferation stimulated by ILM peeling.