Postoperative macular hole formation after vitrectomy with internal limiting membrane peeling for the treatment of epiretinal membrane

Abstract

Purpose: To evaluate the incidence, clinical features, and outcomes of macular hole formation after pars plana vitrectomy with internal limiting membrane peeling for the management of epiretinal membrane.

Methods: Retrospective consecutive chart review of 423 cases.

Results: Eleven subjects developed postoperative macular holes (incidence 2.6%; 95% confidence interval, 1.5-4.6%). Two of the 11 subjects developed central macular holes (incidence 0.5%; 95% confidence interval, 0.1-1.7%) while 9 had eccentric (nonfoveal) macular holes (incidence 2.1%; 95% confidence interval, 1.1-4.0%). Seven of the 9 eccentric macular holes were <115 µm in diameter, 7 were determined to be along the margin of the internal limiting membrane peel, and 8 were either in the superior or temporal macula. The two central macular holes were closed with subsequent pars plana vitrectomy and gas tamponade. There was no association between macular hole formation and age, gender, preoperative visual acuity, axial length, and preoperative central macular thickness. Overall, a 0.2 or more improvement in logMAR was associated with pseudophakia and poorer preoperative acuity on univariate and multivariate analysis, whereas increased preoperative central macular thickness was associated with improved outcomes on univariate but not multivariate analysis.

Conclusion: Postoperative macular hole formation is an infrequent sequela to pars plana vitrectomy with internal limiting membrane peeling for epiretinal membrane. In our cohort, eccentric macular holes tended to be small, located along the edge of the internal limiting membrane peel, and were not visually significant.