A Brüggemann1, H Hoerauf. 1. Klinik für Augenheilkunde, UK-SH, Campus Lübeck. brueggemann.a@web.de
Abstract
BACKGROUND: Therapeutic strategies for macular holes have been optimised during the last years. However, little is known about atypical macular holes. This study was conducted to analyse the clinical and anatomic outcome in secondary macular holes of different origins. PATIENTS AND METHODS: In a retropective analysis 60 eyes with atypical macular holes that underwent surgical repair were identified. Demografic data, lens status, macular situation, best corrected visual acuity (BCVA) pre- and postoperative and complications were documented. After exclusion of patients with trauma, vitreomacular traction syndrome and epiretinal gliosis four subgroups were analysed. Group I: after retinal detachment (n = 6), Group II: with retinal vein occlusion (n = 5), Group III: associated with diabetic macular oedema (n = 6), Group IV: during/after internal limiting membrane peeling (n = 3). RESULTS: I. Four of six eyes showed a macular hole after successful retinal detachment surgery and two eyes in the presence of retinal detachment. Five of six eyes showed postoperative closure of the macular hole. BCVA improved in four eyes, worsened in one eye and remained unchanged in one. II. In five eyes a secondary macular hole occurred after retinal vein occlusion. After vitrectomy and gas tamponade a successful hole repair was observed in all eyes. Improvement of BCVA occurred in four eyes and remained unchanged in one eye. III. In six eyes a secondary macular hole developed after rupture of cysts in diabetic macular oedema. Four of six holes were closed successfully after vitrectomy. Improvement of BCVA was seen in two eyes, impaired BCVA in one eye and in one eye vision remained unchanged. IV. This group consists of two eyes with a macular hole after vitrectomy and membrane peeling and one eye with an iatrogenic intraoperatively created macular hole. After vitrectomy and gas tamponade, anatomic success was achieved in two eyes. Improvement of BCVA was observed in two eyes, in one eye BCVA deteriorated markedly. CONCLUSIONS: In spite of the different underlying diseases and pathomechanisms, secondary macular holes can be treated successfully in the majority of cases. Visual recovery was moderate in patients with diabetic macular oedema but marked in the other subgroups. Therefore, vitrectomy seems reasonable also in non-atypical macular holes of various origins.
BACKGROUND: Therapeutic strategies for macular holes have been optimised during the last years. However, little is known about atypical macular holes. This study was conducted to analyse the clinical and anatomic outcome in secondary macular holes of different origins. PATIENTS AND METHODS: In a retropective analysis 60 eyes with atypical macular holes that underwent surgical repair were identified. Demografic data, lens status, macular situation, best corrected visual acuity (BCVA) pre- and postoperative and complications were documented. After exclusion of patients with trauma, vitreomacular traction syndrome and epiretinal gliosis four subgroups were analysed. Group I: after retinal detachment (n = 6), Group II: with retinal vein occlusion (n = 5), Group III: associated with diabetic macular oedema (n = 6), Group IV: during/after internal limiting membrane peeling (n = 3). RESULTS: I. Four of six eyes showed a macular hole after successful retinal detachment surgery and two eyes in the presence of retinal detachment. Five of six eyes showed postoperative closure of the macular hole. BCVA improved in four eyes, worsened in one eye and remained unchanged in one. II. In five eyes a secondary macular hole occurred after retinal vein occlusion. After vitrectomy and gas tamponade a successful hole repair was observed in all eyes. Improvement of BCVA occurred in four eyes and remained unchanged in one eye. III. In six eyes a secondary macular hole developed after rupture of cysts in diabetic macular oedema. Four of six holes were closed successfully after vitrectomy. Improvement of BCVA was seen in two eyes, impaired BCVA in one eye and in one eye vision remained unchanged. IV. This group consists of two eyes with a macular hole after vitrectomy and membrane peeling and one eye with an iatrogenic intraoperatively created macular hole. After vitrectomy and gas tamponade, anatomic success was achieved in two eyes. Improvement of BCVA was observed in two eyes, in one eye BCVA deteriorated markedly. CONCLUSIONS: In spite of the different underlying diseases and pathomechanisms, secondary macular holes can be treated successfully in the majority of cases. Visual recovery was moderate in patients with diabetic macular oedema but marked in the other subgroups. Therefore, vitrectomy seems reasonable also in non-atypical macular holes of various origins.