Macular hole formation after vitrectomy for retinal detachment

Abstract

Editor, E arlier theories of macular hole (MH) formation include the suggestions that its development is caused by tangential vitreomacular traction (Gass 1995) or cystoid degeneration of foveal inner retinal layers. Further studies using optical coherence tomography (OCT) suggest that vitreofoveal traction plays a major role in the pathogenesis of MH (Haouchine et al. 2001). The primary purpose of vitrectomy is to relieve vitreous traction at the macula; hence, MH formation in an eye that has previously undergone vitrectomy remains a conundrum. We describe five cases of full-thickness MH formation in eyes that had previously undergone vitrectomy performed by five different surgeons (Table 1). The mean age of the patients was 59.6 years and all were male. Four patients initially presented with a macula-off rhegmatogenous retinal detachment (RD) and one with a macula-on tractional RD. They underwent RD repair with uncomplicated three-port pars plana vitrectomy (PPV), cryotherapy to the breaks and gas tamponade (20% SF6 or 14% C3F8). Macular hole was diagnosed 12 days to 4 months postoperatively (Fig. 1A) and confirmed by Stratus OCT (Carl Zeiss Meditec AG, Jena, Germany) (Fig. 1B). Four patients opted for further three-port PPV, internal limiting membrane (ILM) peel and 14% C3F8 gas tamponade with postoperative facedown posturing. In all cases, the retina remained flat after RD repair and the MH T a b le 1 . P a ti en t d et a il s.