Fovea Morphology After Vitrectomy in Eyes With Full-Thickness Macular Hole Coexisting With Diabetic Retinopathy.

Abstract

This work presents the effects of vitrectomy with an inverted internal limiting membrane flap in full-thickness macular holes (FTMHs) in eyes with diabetic retinopathy (DR). Vitrectomy with the inverted and temporal inverted internal limiting membrane flap technique was performed in all cases. Inclusion criteria were FTMH, diabetes treated with oral drugs or with insulin for at least 5 years, spectral-domain or swept-source optical coherence tomography performed before surgery then 1 week, 1, 3, 6, 12, and 18 to 36 months after surgery. FTMH with nonproliferative DR (NPDR) was noted in 20 eyes and with proliferative DR (PDR) in 5 eyes. In PDR the margins of the macular holes (MHs) were always detached, and the MHs tended to be larger than in NPDR. The minimum diameter-to-base diameter ratio was 1:2 in NPDR and 1:10 in PDR. Postoperatively central retinal thickness and visual acuity (VA) were significantly lower for PDR. Twenty-one of 25 FTMHs were closed after the first surgery, and all were closed after the second surgery. VA improved, final results did not depend on FTMH diameter. Photoreceptor defects decreased in size but were present in all cases 12 months after surgery. Morphology of MHs in NPDR and PDR was varied. FTMH in NPDR resembled idiopathic cases; morphology of FTMH with PDR was different. In PDR, FTMHs were larger and the fovea was usually detached; retina thinning was also observed. Final VA depended on initial VA and the severity of the disease (NPDR vs PDR).