Small-gauge vitrectomy associated with likelihood of successful recurrent macular hole closure

Issue: April 10, 2017

FORT LAUDERDALE, Fla. — It is unclear if the use of small-gauge vitrectomy to treat macular holes results in less incidence of recurrent macular holes, but the procedure has a high likelihood of success in treating recurrent macular holes, according to a speaker here.

“There is a high likelihood of successful closure with reoperation, without necessarily doing [internal limiting membrane] flaps and other things, if the holes are regular sized,” Tarek S. Hassan, MD, of the United States, said at the inaugural Retina World Congress.

Tarek S. Hassan

While most macular holes do close after surgery, historically about 4.8% to 9.2% reopen. Small-gauge vitrectomy theoretically has several advantages over traditional methods because it is less invasive, results in less inflammation and may offer less postoperative cystoid macular edema, Hassan said.

In a current retrospective series being conducted by Hassan and colleagues, recurrent macular holes in eyes treated entirely with small-gauge vitrectomy techniques were evaluated. In the series, 392 eyes underwent small-gauge vitrectomy, and all had successful closure of full-thickness macular holes. However, 13 eyes had a reopening of the macular

hole at least 1 month postoperative, Hassan said. All 13 eyes underwent another small-gauge vitrectomy and remained closed after 1 month. However, three eyes had a second reopening, with a range of 5 to 49 months postoperative. One patient chose another vitrectomy with epiretinal membrane peeling and the macular hole was again closed.

At the most recent follow-up, all 11 eyes that underwent surgery still had closed macular holes and experienced a mean visual acuity improvement from 20/148 to 20/89, Hassan said.

However, of the 13 eyes that had reopened macular holes, 77% developed a full-thickness macular hole in the other eye, he said.

“There was something clearly abnormal about the vitreomacular interface with the ILM in these patients,” he said. – by Robert Linnehan

Reference:

Hassan TS. Recurrent macular hole. Presented at: Retina World Congress; Feb. 23-26, 2017; Fort Lauderdale, Fla.

Disclosure: Hassan reports no relevant financial disclosures.