Surgery for bilateral macular holes

Objective To report on bilateral sequential macular hole repair. Design Retrospective case series report. Participants Sixteen eyes of eight patients with reduced visual acuity (VA) and metamorphopsia due to bilateral macular hole. Intervention Patients underwent vitrectomy surgery for bilateral macular hole. Seven patients had both eyes operated on consecutively at the same operating session. One patient had surgery to the fellow eye the next day. Strict facedown posturing was undertaken for 1 week by all patients. Main Outcome Measures Closure of macular hole; final VA; complications. Results In 15 (94%) eyes the macular holes closed with resolution of symptoms; the mean VA at discharge was 6/15; two patients had reduced VA due to age-related macular degeneration (6/36, 6/18); five eyes had entry site tears; there was one case of lens touch with elevated intraocular pressure (IOP); in one (6%) patient the macular hole reopened after later cataract surgery (VA 6/24). Conclusions Surgical closure of bilateral macular holes at the same operating session has distinct advantages but also considerable disadvantages. Case selection is paramount—patients require careful preoperative counselling and postoperative support, especially during the posturing week.