Long-term incidence of reopening of macular holes

Objective: To report the incidence of macular hole reopening after initial successful surgery. Design: A noncomparative retrospective case series. Participants: From a series of 137 consecutive cases of idiopathic macular holes operated on between August 1993 and May 1996, the authors analyzed th e charts of 116 cases of successful surgery. Setting: A single university-based ophthalmology department. Intervention: Pars plana vitrectomy, posterior hyaloid peeling, fluid-air a nd air-gas exchange with a non-expansile 17% C2F6 mixture followed by face- down positioning. Eighty-eight patients (64%) received autologous platelets as a biologic adjuvant. The anatomic success rate at the first postoperati ve month was 116 of 137 (85%). One hundred and six patients (91%) were foll owed up for more than 2 years. Main Outcome Measure: Macular anatomic status. Results: Mean follow-up was 27 months. Eleven eyes of 11 patients (9.5%) ha d reopening of the macular hole. The mean period between hole surgery and r eopening was 15.4 months (range, 8-29). in 8 of these it cases, reopening o ccurred after cataract extraction. In two cases. an epiretinal membrane was noted. In another case cystoid macular edema was present. The final anatom ic success rate with one surgical procedure was 105 of 137 (77%). Eight reo pened holes were reoperated on and all were anatomic successes at 1 month. However, four patients experienced a second reopening. Conclusions: Macular hale reopening occurred in 9.5% of cases (11 of 116). The cause of reopening might have been any anatomic stress such as epiretin al membrane formation or macular edema. However, in most of our reopened ca ses, no definite cause was evident. Four patients experienced recurrent reo pening. (C) 2000 by the American Academy of Ophthalmology.