Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 2395
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO THE EDITOR
Year : 2008  |  Volume : 56  |  Issue : 6  |  Page : 526-527

Sustained closure of surgically repaired macular hole after proliferative vitreoretinopathy


Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan

Date of Web Publication14-Oct-2008

Correspondence Address:
Yoshinori Mitamura
Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.43391

Rights and Permissions

How to cite this article:
Mitamura Y, Yamamoto S. Sustained closure of surgically repaired macular hole after proliferative vitreoretinopathy. Indian J Ophthalmol 2008;56:526-7

How to cite this URL:
Mitamura Y, Yamamoto S. Sustained closure of surgically repaired macular hole after proliferative vitreoretinopathy. Indian J Ophthalmol [serial online] 2008 [cited 2020 Nov 30];56:526-7. Available from: https://www.ijo.in/text.asp?2008/56/6/526/43391

Dear Editor,

There are some reports in which a persistent closure of a surgically repaired macular hole in patients with subsequent retinal detachment (RD) with submacular fluid is described. [1],[2],[3],[4] Here, we report a patient with postoperative macular hole closure who subsequently developed proliferative vitreoretinopathy (PVR) with submacular fluid. Despite the submacular fluid and tangential traction due to PVR, the macular hole remained closed.

A 66-year-old man presented with a two-month history of decreased visual acuity and metamorphopsia in the left eye. On initial examination, his best-corrected visual acuity was 20/200 in the left eye. Fundus examination and optical coherence tomography (OCT) disclosed an idiopathic Stage 3 macular hole [Figure 1A],[Figure 2A].

The patient underwent pars plana vitrectomy combined with phacoemulsification, intraocular lens implantation, internal limiting membrane peeling, and sulfur hexafluoride gas tamponade. Intraoperatively, a large iatrogenic oral dialysis was found in the superonasal quadrant, and scleral bucking was added. The patient was kept face down positioning for 10 days. The patient was asked to maintain facedown position for two weeks.

Two weeks later, his visual acuity was 20/100 in the left eye. The anatomic closure of the macular hole was achieved and confirmed by OCT [Figure 1B], [Figure 2B]. There was no rhegmatogenous RD.

Twelve weeks after the initial vitrectomy, visual acuity decreased to 20/300. Proliferative vitreoretinopathy (Grade CP-12, Type 1) with submacular fluid had developed [Figure 1C]. No defect was observed in the fovea and the previous iatrogenic oral dialysis became unsealed partially. The OCT images demonstrated submacular RD without the reopening of the macular hole [Figure 2C]. Vitrectomy with membrane peeling and silicone tire encircling was performed and retinal reattachment was achieved. The patient kept face down positioning for two weeks. The patient was asked to maintain facedown position for 10 days. After the second surgery, the macular hole remained closed and final visual acuity was 20/200.

A histopathologic study of repaired macular holes after vitrectomy has shown the plugging of a retinal defect by glial tissue. [5] Hainsworth et al. , [1] reported four patients who underwent a successful surgical closure of macular holes and subsequently developed rhegmatogenous RD with macular involvement. No reopening of the original macular hole occurred in these four patients. Hainsworth et al., [1] surmised that the adhesion of macular hole edges to the underlying retinal pigment epithelium is not the main mechanism of hole closure and that the reapproximation of hole edges and the glial bridging of residual foveal defects are important mechanisms.

Tabandeh et al. , [3] reported two cases of macula-involved RD after macular hole surgery. The macular hole remained closed in a case that developed RD 24 months after macular hole surgery, but opened in another case that developed RD two weeks after surgery. They presumed that the seal was not mature enough to withstand the forces generated by the shifting subretinal fluid in the latter case. In our patient, PVR was clinically evident 12 weeks postoperatively. Therefore, the seal might have matured.

In the present report, we describe a sustained closure of a surgically repaired macular hole after PVR with submacular fluid. Despite the submacular fluid and tangential traction to the macula, the macular hole remained closed. This finding suggests that the postoperative adherence of macular hole edges is occasionally firm enough to overcome the tangential traction of PVR.

 
  References Top

1.
Hainsworth DP, Johnson MW, Jaffe GJ. Sustained closure of surgically repaired macular holes after retinal detachment with submacular fluid. Am J Ophthalmol 1997;123:364-9.  Back to cited text no. 1
[PUBMED]    
2.
Heier JS, Topping TM, Frederick AR Jr, Morley MG, Millay R, Pesavento RD. Visual and surgical outcomes of retinal detachment following macular hole repair. Retina 1999;19:110-5.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Tabandeh H, Chaudhry NA, Smiddy WE. Retinal detachment associated with macular hole surgery: Characteristics, mechanism and outcomes. Retina 1999;19:281-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
Herring JH, Chen CJ, Chen LL. Confirmation of persistent closure of surgically repaired macular hole in subsequent retinal detachment by optical coherence tomography. Ophthalmic Surg Lasers 2000;31:243-4.  Back to cited text no. 4
[PUBMED]    
5.
Funata M, Wendel RT, de la Cruz Z, Green WR. Clinicopathologic study of bilateral macular holes treated with pars plana vitrectomy and gas tamponade. Retina 1992;12:289-98.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1A], [Figure 1B], [Figure 1C], [Figure 2A], [Figure 2B], [Figure 2C]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed1508    
    Printed34    
    Emailed0    
    PDF Downloaded155    
    Comments [Add]    

Recommend this journal