title: Iatrogenic eccentric full thickness macular holes following vitrectomy with ILM peeling for idiopathic macular holes.
abstract: OBJECTIVE
  To document a previously unreported complication after vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular holes.
  
  
  METHODS
  Retrospective review of notes of 232 consecutive patients who underwent vitrectomy with peeling of the ILM for idiopathic macular holes from 1996 to 2001. Four patients were found to have eccentric iatrogenic macular holes postoperatively. Optical coherence tomography was used to evaluate these holes.
  
  
  RESULTS
  The idiopathic macular holes were graded from stages II to IV preoperatively with visual acuities from 6/18 to 6/60. All patients had surgery within 6 months of presentation. They underwent vitrectomy with complete separation of the posterior cortical vitreous, peeling of the ILM, injection of platelets (0.1 ml), and gas tamponade with SF6 20%. Postoperatively the patients postured strictly face down for 10 days. Follow-up ranged from 8 months to 6 years. Iatrogenic eccentric macular holes were noted postoperatively. The holes were located between 3 and 6 o'clock in three patients and at 9 o'clock in the fourth patient, relative to the macula. Optical coherence tomography showed them to be full thickness and completely flat. No further intervention was necessary. No complications have arisen during follow-up.
  
  
  CONCLUSIONS
  To our knowledge iatrogenic eccentric full thickness macular holes after macular hole surgery have never been reported. We believe that the location of the holes represents the initial site of ILM elevation. These holes are asymptomatic, have not required any treatment and have not caused any complications in up to 6 years of follow-up.
authors.affiliation: Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK. arubinstein@btinternet.com
authors.forename: A
authors.initials: A
authors.lastname: Rubinstein
authors.forename: R
authors.initials: R
authors.lastname: Bates
authors.forename: L
authors.initials: L
authors.lastname: Benjamin
authors.forename: A
authors.initials: A
authors.lastname: Shaikh
mesh_terms: D000368:Aged; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012167:Retinal Perforations / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects*