Macular hole surgery-associated peripheral visual field loss

To examine in more detail the peripheral visual field loss after macular hole surgery, we reviewed a series of 38 consecutive patients (44 eyes) with idiopathic macular hole who underwent vitrectomy and fluid-gas exchange. Ten (22.7%) eyes of 9 patients developed peripheral visual field loss shortly after successful surgery. This complication was characterized by mild to moderate wedge-shaped visual field loss that predominantly affected the inferotemporal periphery. Of these 9 patients, 2 complained of peripheral visual field loss, and the 7 others remained asymptomatic. The peripheral visual field loss remained unchanged for a mean follow-up of 18.5 months, except in one case of complete recovery. The thickness of the retinal nerve fiber layer was measured postoperatively to determine whether any damage to the optic nerve head had occurred during surgery. The information obtained in this study did not provide conclusive evidence for the understanding of the pathomechanism of the macular hole surgery-associated visual field loss. Peripheral visual field defect after otherwise uneventful surgery for idiopathic macular hole is probably not uncommon. This complication is variable in its severity and is usually permanent. Whether it is caused by any surgical trauma to the optic nerve head remains to be elucidated.