REOPERATION AFTER FAILED MACULAR HOLE SURGERY

Purpose: The authors determined the anatomic and visual success rates of vitrectomy in patients who have failed previous macular hole surger y. Methods: Standardized Early Treatment Diabetic Retinopathy Study (E TDRS)-style best-corrected visual acuity was measured in each patient pre- and postoperatively. Surgery was performed at two centers using a standardized protocol, as previously reported, using 1330 ng bovine-d erived transforming growth factor-beta(2) (TGF-beta(2)) and 16% perflu oropropane internal gas tamponade. Endpoint analyses were conducted fo r anatomic closure of the hole, visual improvement of three or more ET DRS lines, and final visual acuity of greater than or equal to 20/63 a nd greater than or equal to 20/40. Results: Forty-eight eyes failing p revious macular hole surgery were reoperated. The anatomic results sho wed closure of the hole in 40 (83%) cases at the end of the mean follo w-up interval of 7.4 months. The visual acuity improved in greater tha n or equal to three lines in 52%, was greater than or equal to 20/63 i n 54%, and was greater than or equal to 20/40 in 25% of reoperated eye s. The only factor associated with a better final visual acuity was pr eoperative visual acuity better than 20/80. Nuclear sclerosis leading to cataract extraction was observed in 13 (30%) of 43 initially phakic eyes. Conclusion: Macular hole closure was induced in this subset of reoperated patients. Visual improvement occurred often, although in a lower percentage than has been reported for primary surgical eyes. Rep eat vitrectomy should be considered in patients with persistent macula r hole after failure of primary surgery.