Purpose: The purpose of this study is to assess the rate of posterior
segment complications after vitreous surgery for macular holes and to
evaluate the effect of such complications on final visual outcome. Met
hods: The authors reviewed retrospectively all cases of vitreous surge
ry for macular holes performed between June 1990 and October 1993. Amo
ng 98 patients with a followup of 3 months or more, all patients with
posterior segment complications during the postoperative course were i
dentified. The rate of complications was compared with that seen after
vitreous surgery for macular pucker performed by the same surgeons. R
esults: Posterior segment complications were noted in 23 (23%) of 98 p
atients. These included peripheral retinal breaks (3%), rhegmatogenous
retinal detachment from a peripheral retinal break (14%), enlargement
of the hole (2%), late reopening of the hole (2%), retinal pigment ep
ithelium loss under the hole (1%), photic toxicity (1%), and endophtha
lmitis (1%). In 40% of these eyes, the final visual acuity was two lin
es or more below preoperative visual acuity. When compared with the ma
cular pucker group, the rate of posterior segment complications, in pa
rticular the rate of peripheral retinal tears and detachments, was sig
nificantly higher (P less than or equal to 0.05). Conclusions: The aut
hors conclude that visually significant posterior segment complication
s may occur after vitrectomy for macular hole, and the rate of these c
omplications appears to be higher than expected.