Macular atrophy following macular hole surgery assisted by Membrane Blue-Dual: A case series.

Abstract

The aim of this study is to describe the clinical and multimodal imaging findings in patients with macular atrophy following macular hole surgery assisted by Membrane Blue Dual. This study is a monocenter, retrospective, observational case series that included patients who presented macular atrophy following macular hole surgery. Among the patients included in this study, four were operated for idiopathic macular hole and one for total retinal detachment associated with macular hole. In all patients the internal limiting membrane was brittle and adherent and multiple stains were required. One month postoperatively all patients showed a reduced visual acuity excepted the patient with total retinal detachment. At fundus examination all patients showed patchy atrophy with a mottled hypo- and hyperpigmented appearance in the macular region. Optical coherence tomography scans demonstrated a closed macular hole with retinal thinning, disruption of the external retinal layers and irregular retinal pigment epithelium thickening. Fundus autofluorescence showed a well-defined area of both hypo- and hyper-autofluorescence involving the macular area. Macular atrophy following Membrane Blue Dual assisted internal limiting membrane peeling represents a severe complication that vitreoretinal surgeons should be aware of and that should be taken into account in preoperative evaluation and surgical procedure planning. In order to reduce the risk of this complication, we recommend to ensure the best conditions of visibility, to reduce as much as possible the intensity and the distance of the endoillumination from the retina, and to use as little dye as possible.