title: Reoperation after failed macular hole surgery.
abstract: OBJECTIVE
  The authors determined the anatomic and visual success rates of vitrectomy in patients who have failed previous macular hole surgery.
  
  
  METHODS
  Standardized Early Treatment Diabetic Retinopathy Study (ETDRS)-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-derived transforming growth factor-beta 2 (TGF-beta 2) and 16% perfluoropropane internal gas tamponade. Endpoint analyses were conducted for anatomic closure of the hole, visual improvement of three or more ETDRS lines, and final visual acuity of > or = 20/63 and > or = 20/40.
  
  
  RESULTS
  Forty-eight failing macular hole surgery were reoperated. The anatomic results showed closure of the hole in 40 (83%) cases at the end of the mean follow-up interval of 7.4 months. The visual acuity improved in greater than or equal to three lines in 52%, was > or = 20/63 in 54%, and was > or = 20/40 in 25% of reoperated eyes. The only factor associated with a better final visual acuity was preoperative visual acuity better than 20/80. Nuclear sclerosis leading to cataract extraction was observed in 13 (30%) of 43 initially phakic eyes.
  
  
  CONCLUSIONS
  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. Repeat vitrectomy should be considered in patients with persistent macular hole after failure of primary surgery.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Smiddy
authors.forename: R N
authors.initials: RN
authors.lastname: Sjaarda
authors.forename: B M
authors.initials: BM
authors.lastname: Glaser
authors.forename: H W
authors.initials: HW
authors.lastname: Flynn
authors.forename: J T
authors.initials: JT
authors.lastname: Thompson
authors.forename: A
authors.initials: A
authors.lastname: Hanham
authors.forename: R P
authors.initials: RP
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002387:Cataract Extraction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007907:Lens Nucleus, Crystalline / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012167:Retinal Perforations / Q000601:surgery*; D012598:Sclerosis; D017211:Treatment Failure; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy