Risk Factors for Macular Hole Development After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To identify intraoperative and postoperative risk factors for macular hole (MH) formation after prior pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair. Methods: This retrospective case-control study compared eyes that developed MH after PPV for RRD (cases) and those that underwent PPV for RRD without forming MH (controls). Cases were matched to controls using propensity scores based on demographic, preoperative, and RRD characteristics. Results: The study included 44 case eyes and 44 control eyes. Median time to MH formation was 6.3 months. MH repair was successful in 95.1% of eyes, with significant improvement in visual acuity (from 1.05 logMAR to 0.84 logMAR; P = .001). Perfluorocarbon usage was higher at the time of RRD repair in eyes that developed MH (16% vs 0%; P = .012). Post-PPV formation of an epiretinal membrane (ERM) prior to MH was higher in the case group (61% vs 43%; P = .057), as was post-PPV formation of cystoid macular edema (CME) prior to MH (75.9% vs 9.1%; P < .001). Conclusions: This case-control study found that eyes developing post-PPV CME are at highest risk for MH formation after surgery for RRD. The development of MH after PPV for RRD most commonly occurs several months after surgery. Mitigating the formation of ERM and treating postoperative CME are important to long-term visual prognosis after RRD repair.