Peripheral visual field loss after vitreous surgery for macular holes

Vitreous surgery for Idiopathic macular holes can result in both anatomic closure of the hole and visual improvement. In some patients even normal visual acuity is achieved. Postoperative visual field loss is a newly recognized complication. This prospective study evaluates the frequency and significance of scotomas after vitrectomy with gas tamponade for stage I-IV macular holes.

Over a period of 10 months, a consecutive series of 30 patients and 31 eyes with macular holes underwent pre- and postoperative automatic perimetry (Octopus 07, 70 degrees) and macular perimetry (Octopus M1, 24 degrees) to characterize the pattern of visual field defects after vitrectomy with gas tamponade. Success rates were evaluated and complications were analyzed.

Anatomic success after one surgical procedure was achieved in 85% of cases, visual improvement in 58%. Some 70.1% of patients had peripheral scotomas postoperatively; some of these were highly symptomatic and others were detected by visual field testing only. The most consistently affected areas were the temporal and lower periphery of the visual field. The central visual field, however, was not disturbed.

Visual field loss after otherwise successful surgery for macular holes is an unexpectedly frequent and serious complication. The authors discuss various factors that may contribute to the postoperative scotomas. From the localization of the scotomas it seems most likely that they are caused by the persistent pressure of the gas bubble on the peripheral retina. Further investigations are necessary to confirm this hypothesis, and ways must be found to avoid this complication in order to be able to proceed with this otherwise promising new indication group for vitreous surgery.