PERIPHERAL VISUAL-FIELD LOSS AFTER VITREOUS SURGERY FOR MACULAR HOLES

Background: Vitreous surgery for idiopathic macular holes can result i n both anatomic closure of the hale and visual improvement. In some pa tients even normal visual acuity is achieved. Postoperative visual fie ld loss is a newly recognized complication. This prospective study eva luates the frequency and significance of scotomas after vitrectomy wit h gas tamponade for stage I-IV macular holes. Methods: Over a period o f 10 months, a consecutive series of 30 patients and 31 eyes with macu lar holes underwent pre- and postoperative automatic perimetry (Octopu s 07, 70 degrees) and macular perimetry (Octopus M1, 24 degrees) to ch aracterize pattern of visual field defects after vitrectomy with gas t amponade. Success rates were evaluated and complications were analyzed . Results: Anatomic success after one surgical procedure was achieved in 85% of cases, visual improvement in 58%. Some 70.1% of patients had peripheral scotomas postoperatively; some of these were highly sympto matic and others were detected by visual field testing only. The most consistently affected areas were the temporal and lower periphery of t he visual field. The central visual field, however, was not disturbed. Conclusion: Visual field loss after otherwise successful surgery for macular holes is an unexpectedly frequent and serious complication. Th e authors discuss various factors that may contribute to the postopera tive scotomas. From the localization of the scotomas it seems most lik ely that they are caused by the persistent pressure of the gas bubble on the peripheral retina. Further investigations are necessary to conf irm this hypothesis, and ways must be found to avoid this complication in order to be able to proceed with this otherwise promising new indi cation group for vitreous Surgery.