Clinical characteristics and surgical outcomes of secondary full-thickness macular holes developing after vitrectomy

To describe the clinical features, anatomical and visual outcomes of secondary full-thickness macular holes (sFTMH) developing after pars plana vitrectomy (PPV).

The medical charts of patients from nine vitreoretinal services across the UK who, between 2009 and 2023, underwent PPV for different indications and subsequently developed sFTMH were retrospectively reviewed. Primary outcomes were clinical features, macular hole closure rate and change in best corrected visual acuity (BCVA). Patients with idiopathic FTMH (iFTMH) who underwent surgical repair in the same period acted as control data for optical coherence tomography (OCT) characteristics.

Out of 16 939 PPV undertaken during the study period, 60 eyes of 60 patients (52% females, mean age 61.9 years) developed sFTMH, leading to an incidence of 0.4%. Median follow-up was 24.7 months. The median time from primary PPV to sFTMH diagnosis was 3 (range 0.4-81.4) months. OCT features of sFTMH were compared with 108 cases of iFTMH. Epiretinal membrane (ERM, 24.2%), epiretinal proliferation (ERP, 9.3%) and subretinal fluid cuff (53.7%) were more commonly observed in sFTMH compared with iFTMH (11.1%, p=0.03; 1.9%, p=0.03 and 33.3%, p=0.01, respectively). 10.9% of sFTMH developing after rhegmatogenous retinal detachment (RRD) were associated with giant-retinal tear (GRT) RRD. Single surgery success rate was 93.9%. In 3 (5%) eyes, sFTMH closed spontaneously. BCVA significantly improved from 1.0 logMAR to 0.7 logMAR at final visit.

sFTMH presented more commonly with ERM and ERP compared with iFTMH. A high incidence of GRT-related RRD was observed among the RRD cohort. Surgery achieves a closure rate of 93.9% and significant vision improvement.