Cystoid macular edema following combined phacoemulsification and vitrectomy for macular hole

To evaluate the incidence of cystoid macular edema (CME) in patients undergoing either combined or consecutive pars plana vitrectomy (PPV) and phacoemulsification (PE) for the treatment of macular hole and cataract. Retrospective review of a consecutive surgical series of 22 patients with idiopathic macular holes. Seven patients underwent combined PPV with air-fluid-C3F8 gas exchange and PE with intraocular lens insertion; 15 patients underwent PE subsequent to PPV. Visual acuity improved by 2 or more lines in 3/7 patients in the combined group and in 15/15 in the consecutive group. Of seven patients in the combined group, two required a second PPV for treatment of the macular hole and one declined further treatment. Of importance, 3/7 in the combined group and 1/15 in the consecutive group developed clinical and angiographic CME, all treated successfully with sub-Tenon's triamcinolone injections. Both combined PPV/PE and consecutive PPV/PE offer excellent potential therapeutic benefits for the treatment of idiopathic macular holes. The incidence and pathogenesis of CME must be further investigated.