Retinal atrophy and eccentric macular hole after internal limiting membrane peeling: a case report

Area of Science:

• Ophthalmology
• Retinal Surgery
• Surgical Complications

Background:

• Postoperative eccentric macular hole (EMH) formation is a rare complication following pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling.
• This complication can occur after surgery for epiretinal membrane (ERM) or macular hole (MH) treatment.

Purpose of the Study:

• To report a case of eccentric macular hole formation after PPV with ILM peeling for MH repair.
• To discuss potential causes and implications of this rare complication.

Main Methods:

• A 62-year-old male with a full-thickness macular hole underwent 25-gauge PPV with ILM peeling using indocyanine green (ICG) and inverted ILM flap placement.
• Postoperative monitoring included optical coherence tomography (OCT) to assess MH closure and detect subsequent retinal changes.

Main Results:

• Initial MH closure was confirmed postoperatively.
• Progressive inner retinal disorganization, atrophy, and cavitation were observed.
• A parafoveal full-thickness eccentric macular hole (EMH) developed inferiorly at five months post-surgery.

Conclusions:

• This case underscores the risk of retinal atrophy and EMH formation after ILM peeling for MH repair.
• Potential contributing factors include ICG-induced toxicity, Müller cell damage, and fluid shear stress.
• Optimizing ICG protocols and considering safer alternatives like brilliant blue G (BBG) are recommended, along with long-term monitoring.