Evolution and management of macular tractional detachment with a macular hole in the presence of nonperfused hemiretinal vein occlusion.

Abstract

We report iatrogenic occurrence of a macular tractional retinal detachment with macular hole in nonperfused hemiretinal vein occlusion and describe its management with vitrectomy, without internal limiting membrane peeling. A 40-year-old man with diabetes was treated with scatter photocoagulation for a unilateral nonperfused hemiretinal vein occlusion with a florid neovascularization at optic disk and best-corrected visual acuity of 20/200. A month later, he developed an extensive tractional detachment of the posterior pole with a macular hole, with further drop in vision to hand motions. Pars plana vitrectomy was performed with complete removal of the tractional membranes, followed by silicone oil tamponade. No attempt was made to peel the internal limiting membrane. Postoperatively, the retina was reattached with closure of the macular hole. Silicone oil was removed after 4 months. The anatomic outcomes were maintained for more than a year postoperatively. The patient's best-corrected visual acuity recovered to 20/80 by the final follow-up visit. Scatter photocoagulation in retinal vein occlusion is a potentially hazardous intervention in the presence of preexisting fibrous tissue. Macular hole, when coexistent with a tractional retinal detachment, can be closed with vitrectomy and release of traction, without an intentional attempt at hole closure. Good anatomic and visual outcomes are possible with early intervention.