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Case Reports
, 81 (8), 658-62

Late Reopening of Successfully Treated Macular Holes

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Case Reports

Late Reopening of Successfully Treated Macular Holes

M Paques et al. Br J Ophthalmol.

Abstract

Background: Most idiopathic macular holes can be closed by a surgical procedure combining vitrectomy, posterior hyaloid ablation, and fluid-gas exchange followed by postoperative positioning. Reopening of closed macular holes has been reported, but its frequency is not known. Here the incidence of reopening after successful macular hole surgery is reported.

Methods: 77 consecutive cases of idiopathic macular holes operated with autologous platelet injection between July 1993 and October 1995 were reviewed. The procedure consisted of three port vitrectomy, posterior hyaloid removal, nonexpansile fluid-gas exchange, and autologous platelet injection followed by face down positioning. The incidence of reopening was analysed in the cohort of the 72 anatomical successes.

Results: Mean follow up was 12.3 months. The macular hole reopened in five eyes of five patients (five out of 72 patients, 6.9%), in four cases after cataract extraction. In four cases too, an epiretinal membrane was noted, either clinically or during reoperation, and fluorescein leakage in the macular area was present in two cases. Three of the five cases of reopening were reoperated and all three were anatomical successes.

Conclusion: Late macular hole reopening occurred in five out of 72 patient, and in four cases after cataract surgery. The presence of an epiretinal membrane around the hole in four of them suggested that tractional forces were responsible for the reopening. Reoperation, performed in three cases, again closed the macular holes.

Figures

Figure 1
Figure 1
Case 1, a full thickness stage 3 macular hole before and after operation. Top left, red-free photograph. At presentation, macular hole with elevation of edges. Visual acuity (VA) was 20/60. Top right, fluorescein angiography. Faint central hyperfluorescence of the hole (note also the pre-existent extramacular subretinal pigmentation). Bottom left, red-free photograph. Closure of the macular hole 1 month after surgery. VA=20/30. Bottom right, fluorescein angiography. The central hyperfluorescence has disappeared.
Figure 2
Figure 2
Case 1. Macular hole reopening after cataract extraction, and closure after reoperation. Top left, blue filter photograph: reopening of the macular hole with epiretinal membrane formation 7 months after cataract surgery and 19 months after macular hole surgery. VA=20/125. Top right, fluorescein angiography. Round central hyperfluorescence of the hole and moderate intraretinal dye leakage, with no cystoid spaces in the macula. Bottom left, red-free photograph. Closure of the hole after reoperation and complete removal of the epiretinal membrane. VA= 20/50. Bottom right, fluorescein angiography showing faint residual hyperfluorescence around the macula.

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