Retinal Detachments Following Successful Idiopathic Macular Holes Surgery

Purpose: : To evaluate long term outcome of successfully operated idiopathic macular holes (IMH).Methods: : We conducted a comparative retrospective case series in two academic centers. IMH were operated with pars plana vitrectomy, intravitreal gas and internal limiting membrane peeling between 2002 and 2005. All these macular holes were analyzed with Stratus OCT before and after the surgery. We divided them into 4 groups: group 1: vitrectomy in pseudophakic eyes; group 2: vitrectomy and cataract extraction as a combined procedure; group 3: vitrectomy followed by cataract extraction; group 4: vitrectomy in pseudophakic eyes. We noted the anatomical and functional results and we studied serious posterior segment complications. Patients with previous or concurrent rhegmatogenous retinal detachment (RD) were excluded from the study.Results: : 135 eyes of 130 patients were included: group 1=22 eyes; group 2=49 eyes; group 3=53 eyes and group 4=11 eyes. The stages of IMH were as follows: stage 2, n=19; stage 3, n=101 and stage 4, n=15. Mean follow-up was 37±9 months (range, 30-67), and mean preoperative IMH diameter was 454±191 µm. We did not observe any recurrence of macular hole during the follow-up. The following posterior complications were noted: 17 peroperative retinal breaks, 8 peroperative and 10 (7.4%) postoperative retinal detachments (6 women, 4 men). Lens status did not influence the rate of RD. Mean time of postoperative retinal detachments was 10±15 months. In 3 eyes with RD, the retinal tear has been already treated during the initial IMH surgery by retinocryopexy and gas. Excepted for one eye which has been treated with silicone oil, 9 out of 10 eyes had a mean improvement of visual acuity from 0.87±0.28 to 0.37±0.39 LogMAR.Conclusions: : We did not find any reopening of successfully operated IMH during a three year follow-up. Retinal detachment remains the most common serious complication of macular surgery. Careful intraoperative examination and immediate treatment of the breaks may prevent the development of retinal detachment. However a careful and long follow-up is needed to detect new retinal detachments