Secondary Macular Holes Post Pars Plana Vitrectomy

Area of Science:

• Ophthalmology
• Retinal Surgery
• Macular Diseases

Background:

• Pars plana vitrectomy is a common surgical procedure for various retinal conditions.
• Secondary full-thickness macular holes (FTMHs) can occur as a complication post-vitrectomy.
• Understanding the incidence, presentation, and outcomes of these secondary FTMHs is crucial for patient management.

Observation:

• A retrospective review of 523 vitrectomized eyes identified six cases (1.1% incidence) of secondary FTMHs.
• The primary indications for vitrectomy included rhegmatogenous retinal detachment (RRD), sub-ILM hemorrhage, vitreous hemorrhage from PCV, and pre-Ahmed glaucoma drainage device insertion.
• FTMHs were diagnosed within one week to three months post-vitrectomy, with a mean best-corrected visual acuity (BCVA) of log MAR 0.9 (Snellen: 6/54).

Findings:

• The inverted internal limiting membrane (ILM) flap technique was employed for surgical closure.
• Anatomical closure was achieved in most cases, with three eyes closing after one surgery.
• Marginal visual improvement was noted post-surgery, with a mean BCVA improving from log MAR 0.82 to 0.72 in surgically closed eyes.
• Photodynamic therapy (PDT) was successful in one case of polypoidal choroidal vasculopathy (PCV).

Implications:

• Post-vitrectomy FTMH is a rare but significant complication.
• The inverted ILM flap technique is effective for anatomical closure of secondary FTMHs.
• Visual outcomes for secondary FTMHs appear less favorable compared to idiopathic macular holes, highlighting the need for further research and management strategies.