Functional and anatomic outcomes of pars plana vitrectomy for macular holes in ocular Behçet's disease

To evaluate the outcomes of pars plana vitrectomy (PPV) for full thickness macular holes (FTMH) in ocular Behçet's disease.

Eyes with FTMH as confirmed on optical coherence tomography in patients with active ocular Behçet's disease (AOBD) were included in this study. These eyes underwent PPV, epiretinal membrane (ERM) removal, internal limiting membrane (ILM) peel, and a tamponade injection. Postoperative visual improvement and macular hole closure at 6months was recorded.

Fifteen FTMHs in 14 patients with AOBD were included, with a mean age of 29.3years (25-38), and 13 were males. All patients presented best corrected visual acuity (BCVA) of 0.05 decimals or worse; mean 0.04±0.01 (0.02-0.05). All eyes underwent PPV, 11 eyes needed phacoemulsification, and the ILM was not peeled in one eye. Three eyes had total retinal detachment (RD) and needed silicone oil as a tamponade; the rest received SF6. Macular hole closure was achieved in 14 eyes with a single procedure, and the failed eye was the one with no peeling of the ILM. In the 14 eyes with successful outcomes, a thick ERM and ILM were noted and removed. All patients were followed for at least six months; mean 13months (6-48). The mean BCVA improved to 0.15±0.02 decimals (0.1-0.4) in the first 3months in eyes with successful closure. All patients had recurrent activity during the follow-up period and responded to systemic and local treatment, but with visual loss due to macular ischemia; at 6months, BCVA was 0.06±0.03 decimals (0.03-0.07).

FTMH can occur in AOBD and can progress to RD in the absence of myopia. PPV, ERM removal, ILM peel, and either gas or silicone oil injection gives excellent anatomic results with significant visual improvement. However, full visual recovery is frequently undermined by the associated retinal ischemia and recurrent inflammation.