Increased Reoperation Rate in Surgical Treatment of Rhegmatogenous Retinal Detachment with Coexistent Macular Hole

To examine the surgical outcomes in patients with coexistent macular hole (MH) and rhegmatogenous retinal detachment (RRD).

Retrospective case series.

All patients who underwent surgical repair of concomitant MH and retinal detachment (MHRD) between January 2014 and December 2016 in our facility were examined. At least 1 retinal break was noted in all MHRD cases. Exclusion criteria included MHRD related to high myopia without peripheral retinal tears.

Retrospective chart review.

Data collected included presence of proliferative vitreoretinopathy (PVR) and classification at time of surgical repair, details of surgical repair including whether internal limiting membrane (ILM) peeling was achieved, type of ILM staining used, presence of retinal detachment (RD) in the fellow eye, and duration of follow-up. Outcomes evaluated included visual acuity comparisons, reoperation rate, final anatomic success, and MH closure rate.

Over the study period, MHRD cases accounted for 17 of 745 (2.3%) of all repaired RDs in our practice. Proliferative vitreoretinopathy was present in 53% of MHRD cases. Reoperation rates for MHRD were significantly higher than our practice average for all RD repairs (29% vs. 9.7%; P = 0.01). Final anatomic success with RD was achieved in 100% of patients. Internal limiting membrane peeling was performed in 15 of 17 patients. Macular hole closure rate was 71% after initial surgery. Although 82% of patients experience equal or improved vision, only 24% of patients achieved visual acuity better than 20/80. Retinal detachment in the contralateral eye was noted in 3 of 16 patients (19%) included before initial presentation or during the follow-up period.

Visual outcomes in MHRD cases were underwhelming because of high rates of presentation with PVR macula-off RRD, high reoperation rates, and relatively low MH closure rates. We suggest aggressive surgical techniques to repair MHRD.