Abstract
BackgroundTo report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced full-thickness macular holes (MHs).MethodsThis retrospective study enrolled 10 patients who underwent vitrectomy for MHs caused by laser injury. Best corrected visual acuity (BCVA), macular spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA) were used for assessment.ResultsFour patients were injured by unexpected expose of an yttrium aluminum garnet (YAG) laser, and six patients were accidentally injured by a handheld laser. The MH minimum diameters (MDs) ranged from 55 to 966 μm (mean = 548.00 ± 286.10 μm), and BCVA ranged from 20/400 to 20/50 (mean = logMAR 0.87 ± 0.29) preoperatively. All 10 eyes underwent PPV, internal limiting membrane (ILM) peeling, and gas tamponade. All eyes demonstrated closure of the MH with different degrees of discontinuity of the outer layer of the retina, and four eyes exhibited serious retinal pigment epithelium (RPE) destruction. Postoperative BCVA values were significantly improved (mean = logMAR 0.55 ± 0.33; P = 0.032, t = 2.234). The mean BCVA of the destroyed RPE group was significantly worse than that of the non-destroyed RPE group both before and after surgery (P = 0.019; Wilcoxon signed rank test). Further, OCTA indicated choroidal ischemia in the laser-induced MHs.ConclusionVitrectomy can be successful in closing laser-induced full-thickness MHs and improving visual acuity. However, If RPE/choroid is involved in laser damage in addition to the outer retinal layer, this may indicate poor visual prognosis.
Highlights
To report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced fullthickness macular holes (MHs)
Through OCT angiography (OCTA), we demonstrated choroidal ischemia caused by laser injury in Patients 2, 3, and 9.The areas of flow deficit demonstrated in the rectangular circle showed choroidal ischemia in P2, P3, and P9 in comparison to their fellow eyes (Fig. 3), which indicated that the depth of laser damage to the eye was capable of reaching the choroid
The results demonstrated that laser-induced MH responded well to vitrectomy, with anatomic closure of the macular hole and improvement of visual acuity, though various degrees of outer retina defects remained
Summary
To report the structure and visual outcomes of pars plana vitrectomy (PPV) for laser-induced fullthickness macular holes (MHs). Reports of laser-induced macular holes (MHs), a special subtype of secondary MHs, have increased in recent years [1,2,3]. A careful review of medical history is essential for the correct clinical diagnosis. The type of laser can be neodymiumdoped yttrium aluminum garnet (Nd:YAG) or handheld lasers. Pars plana vitrectomy (PPV) has been used for the treatment of this condition
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