Eccentric Macular Hole after Pars Plana Vitrectomy for Epiretinal Membrane Without Internal Limiting Membrane Peeling: A Case Report

Time course of eccentric macular hole formation after pars plana vitrectomy for epiretinal membrane detected by optical coherence tomography

Purpose

This case report aims to describe the detailed time course of eccentric macular hole (MH) formation following pars plana vitrectomy (PPV) for epiretinal membrane (ERM) treatment, using optical coherence tomography (OCT) images.

Observations

A 60-year-old male patient presented to our hospital with complaints of blurred vision and distortion in his left eye. He was diagnosed with an ERM in the affected eye and subsequently underwent PPV with internal limiting membrane peeling. The patient's initial postoperative course was unremarkable; however, one month later, macular edema worsened, as evidenced by OCT findings. Initially, the edema was observed in both nasal and temporal to the fovea. However, four months postoperatively, the retina fluid in the area nasal to the fovea resolved, and the resolution was delayed in the area temporal to the fovea. At 18 months postoperatively, an eccentric macular hole was detected in the temporal to the fovea. The patient remained asymptomatic, and at the two-year follow-up, the eccentric macular hole demonstrated no signs of enlargement.

Conclusions and Importance

This case demonstrates the progression of an unusual asymptomatic parafoveal full-thickness retinal hole after PPV for ERM treatment. Since the development of this condition may occur over a more extended postoperative period than previously reported, long-term patient monitoring is essential following ERM or MH surgery.

Modified inverted internal limiting membrane flap technique for macular hole closure

PURPOSE

To investigate the efficacy of modified internal limiting membrane (ILM) flap technique combined with vitreous surgery for treating macular holes and examine the outcomes in visual function and anatomic macular hole closure.

STUDY DESIGN

Retrospective, observational.

METHODS

Between July 1, 2015, and October 1, 2019, the modified inverted ILM flap technique combined with vitreous surgery was used to treat idiopathic macular holes, postoperative progression was then followed for at least 6 months in 96 participants (98 eyes). We modified the method by removing the lower half of the ILM while peeling and inverting the upper half. The mean age of the participants was 65.9 ± 11.9 years (41 men (42.7%) and 55 women (57.3%)). Retrospective evaluations of macular hole diameter, corrected visual acuity, and macular hole closure rates were performed using data from medical records.

RESULTS

The mean macular hole diameter was 623.6 ± 207.4 μm. The mean corrected visual acuity (logMAR) was 0.79 ± 0.27 before surgery and 0.46 ± 0.35 at 1, 0.35 ± 0.39 at 3, and 0.31 ± 0.36 at 6 months Post surgery, showing significant differences before and after surgery (p = 2.30 × 10^- 2). The macular hole closure rate was 98%.

CONCLUSION

The modified inverted ILM flap technique combined with vitreous surgery was an effective method for treating macular holes, resulting in improvement in closure and visual acuity.

EFFECT OF LASER PHOTOCOAGULATION ON MACULAR EDEMA ASSOCIATED WITH MACULAR HOLES

PURPOSE

To report the outcomes of laser therapy to barricade eccentric full-thickness macular hole with associated cystoid macular edema.

METHODS

We report two patients who developed an eccentric full-thickness macular hole with persistent cystoid macular edema after pars plan vitrectomy with and without internal limiting membrane peel for epiretinal membrane and the results of argon laser therapy.

RESULTS

Barricade argon laser therapy was applied concentric to the full-thickness macular hole. Associated cystoid macular edema was noted to resolve within 1 to 3 months of therapy in both cases.

CONCLUSION

Barricade laser therapy surrounding a macular hole can lead to resolution of associated cystoid macular edema. Pathogenic mechanisms to explain this favorable outcome are discussed.

Spontaneous closure of secondary eccentric macular holes following vitreoretinal surgery

PURPOSE

To report two cases of secondary eccentric macular holes that developed following vitrectomy and present their outcomes.

METHODS

Retrospective, observational case report CASE DESCRIPTION:: A 69-year-old female and a 57-year-old male developed secondary paracentral retinal hole following vitrectomy surgery for stage 4 macular hole and proliferative diabetic retinopathy respectively. In case 1, the hole was left untreated while in case 2, laser photocoagulation was done around the paracentral retinal hole. In both cases, spontaneous closure of the paracentral retinal holes was noted 12-week and 3-week following presentation respectively.

CONCLUSIONS

Secondary eccentric retinal holes are extremely rare following vitrectomy. The pathogenesis of MHs in our cases is most consistent with contraction of the residual ILM or preretinal fibrous tissue. Spontaneous closure of small eccentric retinal holes can occur as well which to the best of our knowledge has not yet been reported in literature.