Postoperative Full-Thickness Macular Hole Formation after Vitrectomy for the Removal of Epiretinal Membrane

To evaluate the incidence, clinical features, risk factors, and outcomes of full-thickness macular hole (MH) formation after pars plana vitrectomy (PPV) for the removal of epiretinal membrane (ERM).

This retrospective study reviewed the medical charts of the 309 eyes of 306 patients with PPV for ERM removal from 2012 to 2024 using clinical data warehouse search. Patients were categorized into two groups: one group with development of MH and the other without MH development after ERM surgery. Baseline demographics and clinical parameters were compared between the two groups. Risk factors for MH formation were analyzed using univariate and multivariate logistic regression. Surgical outcomes of the cases with MH formation were also analyzed.

A total of 141 eyes were included. Five cases (3.5%) developed MH after PPV for ERM removal. In all five cases (100%), ERM was observed at MH detection. In four of the five patients (80%), cystoid macular edema (CME) was present at MH detection. ERM with lamellar hole was significantly associated factors for MH formation (odds ratio [OR], 13.11; p = 0.018). Preoperative central macular thickness (CMT) showed a marginal association (OR, 0.98; p = 0.075). Among the four patients who underwent surgery, macular hole was successfully closed in three cases. There was no significant difference in best-corrected visual acuity before and after MH surgery.

ERM with lamellar hole was a significant factor for MH formation, while thin preoperative CMT showed a marginal association. At the time of MH detection, ERM and CME were observed in most cases, suggesting that tangential traction caused by postoperative ERM or, postoperative CME may represent possible etiologies for MH formation. In patients with ERM with lamellar hole or thin CMT, the possibility of MH formation after ERM surgery should be taken into account and careful monitoring is needed.