VISUAL-FIELD DEFECTS AFTER MACULAR HOLE SURGERY

PURPOSE: To describe a group of patients with dense visual field defec ts following macular hole surgery. METHODS: Nine (7%) of 125 patients reviewed noted onset of dense visual field defects following uncomplic ated vitrectomy with gas-fluid exchange for the treatment of macular h ole, Patient records were reviewed to investigate the etiology of thes e defects. RESULTS: Eight (89%) of nine eyes that had surgery for macu lar hole developed dense, wedge-shaped visual field defects in the tem poral periphery, One eye had an inferonasal wedge-shaped defect extend ing to fixation. Seven (78%) of nine eyes had generalized or focal nar rowing of the retinal arteriole extending into the area of retina corr esponding to the visual field defect, and five (56%) of nine eyes deve loped mild to moderate segmental nasal optic disk pallor. Postoperativ e fluorescein angiography disclosed one eye with delayed filling of th e retinal arteriole extending into the area of retina corresponding to the visual field defect. Vitrectomy specimens showed no evidence of n erve fiber layer or internal limiting membrane in eight (89%) of nine eyes. CONCLUSIONS: Visual field defects can occur following vitrectomy and gas-fluid exchange for macular hole. The most common visual field defect is dense and wedge shaped and involves the temporal visual fie ld. Although unclear, the etiology may involve trauma to the peripapil lary retinal vasculature or nerve fiber layer during elevation of the posterior hyaloid or during aspiration at the time of air-fluid exchan ge, followed by compression and occlusion of the retinal peripapillary vessels during gas tamponade.