Late Re-opening of Macular Holes after Initially Successful Treatment with Vitreous Surgery

Abstract

In more than 50% of eyes with idiopathic, full-thickness macular holes, vitrectomy results in clinical closure of the hole and improvement in visual acuity. Other than cataract formation, late complications of the procedure have not been reported. Over a 4-year period, 167 eyes underwent successful vitreous surgery for idiopathic macular holes documented by clinical closure of the hole and an improvement in visual acuity of at least two Snellen lines. The authors retrospectively studied eight of these eyes. All initially had successful surgery; however, they subsequently had spontaneous late re-opening of the macular hole with acute diminution in vision. Late re-opening developed in these eyes between 2 and 22 months after initial surgery. The mean time for re-opening was 12.5 months. Three of eight eyes underwent a second vitrectomy, which was successful in improving visual acuity in two eyes. Another patient manifested the growth of an epiretinal membrane that apparently sealed the re-opened macular hole and improved vision. Late re-opening can complicate initially successful macular hole surgery and may occur in at least 4.8% (8 of 167) of initially successful operations. Re-opening has been documented as late as 22 months after initial surgery. Repeat vitrectomy with gas injection may result in reclosure of the hole and improvement in vision.