Surgical Outcomes for Patients who Develop Macular Holes After Pars Plana Vitrectomy

Purpose To characterize outcomes for patients who develop full-thickness macular holes after pars plana vitrectomy. Methods We retrospectively analyzed data for 47 consecutive patients (47 eyes) who developed full-thickness macular holes after initial pars plana vitrectomy for a variety of indications. All patients underwent a second vitrectomy and gas tamponade with or without internal limiting membrane peeling. Results Indications for initial vitrectomy included idiopathic epiretinal membranes (11 eyes), epiretinal membranes with a pseudohole (nine eyes), macular edema resulting from various conditions (nine eyes), proliferative diabetic retinopathy (nine eyes), rhegmatogenous retinal detachment (five eyes), and miscellaneous causes (four eyes). Mean interval from initial vitrectomy to macular hole formation was 20.4 months. Mean visual acuity (VA) in the affected eye was 0.13 (20/155, Snellen equivalent). The hole was closed in 32 eyes (68%) after a single procedure. With a mean follow-up of 53 months, mean final VA improved to 0.26 (20/77); 26 (55%) eyes improved, 18 (38%) were stable, and three (6%) worsened. No severe complications occurred except one macular hole that reopened after successful closure. Conclusions Macular holes may develop after pars plana vitrectomy. Although additional vitrectomy can successfully close the hole and improve vision in most patients, postsurgical outcome seems to depend on the underlying condition.