MEMBRANECTOMY AND AUTOLOGOUS SERUM FOR THE RETREATMENT OF FULL-THICKNESS MACULAR HOLES

Objective: To determine the efficacy of reoperation with rigorous epir etinal membrane dissection and autologous serum for full-thickness mac ular holes remaining open after initial surgery. Methods: Forty-six co nsecutive eyes that had previously undergone unsuccessful macular hole surgery were re-treated with epiretinal membrane dissection, adjuncti ve autologous serum, and 16% perfluoropropane (C3F8) gas tamponade. An atomical closure and improvement of best-corrected Snellen visual acui ty were used as outcome measures, and nuclear sclerosis was graded cli nically before and after reoperation. Results: Epiretinal membrane was identified and dissected in 29 (63%) of the 46 eyes and anatomical cl osure was achieved in 37 (80%) of the 46 eyes. Of these, 23 (62%) of 3 7 improved by at least 2 Snellen lines, 12 (35%) of 37 by at least 3 S nellen lines, and 6 (16%) of 37 by al least 4 Snellen lines. Increase in nuclear sclerosis occurred in 30 (65%) of the 46 eyes postoperative ly, leading to cataract extraction in 12 (26%) of the eyes at last fol low-up (mean, 10.3 months). A longer total duration (P<.001) and a wor se preoperative visual acuity (P=.001), prior to reoperation, were ass ociated with a worse final visual acuity after surgery. Conclusions: R etreatment with rigorous membranectomy and autologous serum seems to b e beneficial in most eyes in which initial macular hole surgery has fa iled. Although the anatomical closure rate is similar to that reported after primary surgery, final visual acuity improvement seems to be le ss than after successful primary closure, owing to the longer mean dur ation of holes in which initial surgery has failed.