Characteristics and Surgical Outcome of Macular Holes Developing after Rhegmatogenous Retinal Detachment Repair

Sang Youn Han; Seul Gi Yoo; Young Ju Lew; Su Jin Yu; Jung Il Han; Dong Won Lee; Sung Won Cho; Tae Gon Lee; Chul Gu Kim; Jung Woo Kim; Joo Yeon Kim

doi:10.3341/jkos.2014.55.10.1487

Journal List > J Korean Ophthalmol Soc > v.55(10) > 1009808

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Han, Yoo, Lew, Yu, Han, Lee, Cho, Lee, Kim, Kim, and Kim: Characteristics and Surgical Outcome of Macular Holes Developing after Rhegmatogenous Retinal Detachment Repair

Original Article

J Korean Ophthalmol Soc 2014;55(10):1487-1492.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.10.1487

Characteristics and Surgical Outcome of Macular Holes Developing after Rhegmatogenous Retinal Detachment Repair

Sang Youn Han, MD, Seul Gi Yoo, MD, Young Ju Lew, MD, Su Jin Yu, MD, Jung Il Han, MD, Dong Won Lee, MD, Sung Won Cho, MD, Tae Gon Lee, MD, Chul Gu Kim, MD, Jung Woo Kim, MD, Joo Yeon Kim, MD

Myunggok eye research institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Joo Yeon Kim, MD, Department of Ophthalmology, Konyang University Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 150-034, Korea, Tel: 82-2-2639-7811, Fax: 82-2-2671-6359 E-mail: redmanson@kimeye.com

Received 11 April 2014 Revised 14 June 2014 Accepted 29 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the characteristics and surgical outcome of macular holes (MHs) that develop after rhegmatogenous retinal detachment (RRD) repair.

Methods

A retrospective chart review was performed in patients who developed a new full-thickness macular hole after RRD repair between May 2010 and July 2013. For eyes that underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for MH repair, main outcomes included macular attachment status and postoperative visual acuity.

Results

Fourteen full-thickness MHs were detected in a series of 2,815 eyes (0.49% prevalence) that had undergone prior RRD surgery. Ten MHs developed after primary vitrectomy and four after scleral bucking surgery. The fovea was detached in eight of the 14 eyes at the time of RRD. Fourteen of 14 eyes were managed by pars plana vitrectomy, internal limiting membrane peeling, and intravitreal gas tamponade, and 12 of 14 eyes achieved MH closure. Mean preoperative Snellen best-corrected visual acuity (BCVA) was 20/63 (±0.25). Nine of 14 eyes had an improvement in visual acuity of at least two Snellen lines, and five eyes remained unchanged.

Conclusions

In this small retrospective study, the secondary MHs were found predominantly in foveal detachments after RRD repair, most commonly occurring after primary vitrectomy. In conclusion, the surgical outcome and postoperative visual acuity improvement were satisfactory, although the final BCVA depended on the macular status during the RRD.

Keywords: Macular hole, Retinal detachment, Surgical outcome

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Figure 1.

Optical coherence tomography images of patient number 12 that were taken at the diagnosis of retinal detachment (macular-spared) (A), 22 months after rhegmatogenous retinal detachment repair, macular hole had developed (B). 2 months after additional vitrectomy, internal limiting membrane peeling and fluid-gas exchange, macular hole had closed (C). The best-corrected visual acuity measured at each time point was 20/40, 20/50, 20/25, respectively.

Table 1.

Characteristics of 14 patients who had macular holes that developed after prior rhegmatogenous retinal detachment repair

Patient number	Sex	Age (years)	Macula -off / Macula -on RRD	Lens status	Presence of other retinal disease at MH diagnosis	Type of RRD repair	Time from RRD to MH (months)	BCVA at RRD diagnosis	BCVA at MH diagnosis	Final BCVA	Pre-oprefractive errors (diopter)	Axial length (mm)	PVD status at MH repair	MH closure
1	M	50	Off	Phakic	None	SB	0.5	0.2	0.04	0.4	−5.50	27.38	Yes	Yes
2	F	61	Off	Phakic	None	SB	0.5	0.04	0.04	0.04	−4.50	23.06	Yes	Yes
3	M	61	Off	Phakic	CME	SB	1	0.04	0.04	0.3	2.00	23.84	No	Yes
4	M	66	Off	Phakic	CME	V	1	0.04	0.06	0.3	−3.50	24.13	Yes	Yes
5	M	62	Off	Phakic	CME	SB	2	0.2	0.2	0.3	−1.25	24.11	Yes	Yes
6	F	36	On	Phakic	ERM	V	3	0.5	0.2	0.9	−1.75	24.57	Yes	Yes
7	M	69	Off	Psedo-phakic	CME	V	3	0.2	0.1	0.2	0.00	23.61	Yes	Yes
8	M	12	On	Phakic	CME	V	9	0.7	0.7	1.0	0.75	23.93	Yes	Yes
9	M	54	On	Psedo-phakic	CME	V	16	0.7	0.6	0.8	0.50	27.37	Yes	Yes
10	F	48	On	Psedo-phakic	CME	V	21	0.5	0.3	0.3	−2.50	23.80	Yes	Yes
11	F	57	On	Phakic	ERM	V	21	0.5	0.3	0.5	0.50	24.37	Yes	Yes
12	M	53	On	Psedo-phakic	CME	V	22	0.5	0.4	0.8	−3.75	25.41	Yes	Yes
13	M	42	Off	Phakic	ERM	V	75	0.06	0.06	0.1	−8.25	27.21	Yes	No
14	M	52	Off	Phakic	CME	V	95	0.15	0.1	0.1	−9.00	28.31	Incomplete	No

RRD = rhegmatogenous retinal detachment; MH = macular hole; BCVA = best corrected visual acuity; PVD = posterior vitreous detachment; CME = cystoid macula edema; ERM = epiretinal membrane; SB = scleral buckling; V = vitrectomy.

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