Development of a full thickness macular hole after vitrectomy for rhegmatogenous retinal detachment: a sequential study via optical coherence tomography

Abstract

BackgroundTo demonstrate a full thickness macular hole (MH) development after vitrectomy (VT) for rhegmatogenous retinal detachment (RRD) and to investigate the possible disease mechanism with optical coherence tomography (OCT).Case presentationA 47-year-old female underwent 23G vitrectomy surgery to repair the macula-detached RRD successfully. However, intraretinal cysts initially developed two months after surgery. Cysts gradually increased in number and size, and cystoid macular edema was noted at the 5th month. Thereafter, inner retina dehiscence and a lamellar macular hole developed. The lamellar hole further dehisced and progressed into a full-thickness MH at the 10th month. The patient then received 23G vitrectomy and internal limiting membrane peeling surgery. OCT and fundus picture showed macular hole sealed 10 days afterward.ConclusionsThe mechanism of secondary MH included tangential traction, cystoid degeneration of macula, and glial migration. The sequential OCT studies provide evidence to support the disease mechanism of cystoid degeneration of the macula.

Surgical Management of Full-Thickness Macular Holes Spontaneously Arising From Lamellar Macular Holes

“…Based on the 13 studies using ILM peeling, the hole-closure rate was 85% (34/40). Demographic data were available for 9 studies 2,3,6,8,10 –12,15,17 (n = 35) with ILM peeling. These patients had a mean age of 58.5 ± 14.8 years, and 54.3% were men.…”

“…These patients had a mean age of 58.5 ± 14.8 years, and 54.3% were men. The BCVA data were available for 8 studies 2,3,6,10 –12,15,17 (n = 30) of ILM peeling. The mean BCVA improved from 0.64 ± 0.46 logMAR (Snellen 20/87) preoperatively to 0.25 ± 0.22 logMAR (Snellen 20/36) postoperatively.…”

“…Sixteen studies 2,3,5,6 –18 with a combined sample of 76 eyes (n = 76) were included (Table 1). Thirteen studies 2,3,6 –12,14 –17 (n = 40) used ILM peeling, 1 study 5 (n = 32) used inverted ILM flap techniques, and 2 studies 13,18 (n = 4) did not specify the surgical technique.…”

Post-vitrectomy secondary macular holes

“…An MH can result either by the direct rupture of the cyst or more commonly by the slow degenerative dehiscence of the glial tissue tuff. [ 7 - 11 ] Cystoid macular changes predisposing to the secondary MH can be seen in multiple clinical settings: one, retinal vasculopathies; two, chronic retinal detachment (degenerative and inflammatory); three, postoperatively (inflammatory); four, traumatic (inflammatory and degenerative). Nonsteroidal anti-inflammatory drugs have been successful in the closure of some secondary small MHs and can be tried before surgical intervention.…”

Optical Coherence Tomography Findings in Rhegmatogenous Retinal Detachment: A Systematic Review

“…Although some authors have performed OCT studies specifically focused on the postoperative period in order to study surgical complications, such as macular hole formation, these findings will be only briefly touched on the present review [ 9 , 10 ].…”