Persistent Subretinal Fluid After Successful Full-Thickness Macular Hole Surgery: Prognostic Factors, Morphological Features and Implications on Functional Recovery.

Abstract

The present study aimed to identify preoperative factors that predispose the development of subretinal fluid (SRF) following successful macular hole (MH) surgery. Thirty-four eyes of 33 consecutive patients that underwent pars plana vitrectomy for idiopathic full-thickness MH surgery were included in this retrospective study. Best corrected visual acuity (BCVA), and spectral domain-optical coherence tomography (OCT) images were evaluated pre- and postoperatively in all cases. Patient's demographic characteristics, stage of MH, measurements of base diameter and minimum aperture diameter of the MH, preoperative foveal vitreomacular traction and selected intra-operative parameters were correlated with the development of postoperative SRF. Postoperative SRF was observed in 15 cases (48%). Total absorption of SRF was observed in 73% of affected eyes and was most commonly seen between the third and the fifth postoperative month. One patient developed lamellar hole leading to full-thickness MH. Postoperative BCVA was similar between the eyes that did and the eyes that did not develop postoperative SRF (0.31±0.2 vs 0.35±0.2; p≥0.05). Development of postoperative SRF was significantly associated with the presence of preoperative foveal vitreomacular traction (p=0.048), stage II MH (p=0.017) and smaller size of the closest distance between the MH edges (p=0.046). Postoperative SRF is a common occurrence following successful MH surgery. Meticulous evaluation of preoperative clinical and OCT findings may disclose risk factors associated with this condition. Based on our observations, idiopathic holes of early stage appear to be at a higher risk of developing postoperative SRF. This could be a point of interest with the advancing use of enzymatic proteolysis.