Is it worth reoperating on macular holes?
OBJECTIVE
To evaluate the visual outcome after a second surgical attempt to close idiopathic full-thickness macular holes (FTMH) in patients who underwent unsuccessful primary surgery and in patients with reopened FTMHs.


METHODS
Retrospective single-center case series.


METHODS
Five hundred thirty-two patients underwent surgery for FTMH in St. Paul's Eye Unit, Liverpool, United Kingdom, between March, 1995, and March, 2005. Fifty-one patients had unclosed FTMHs (unclosed group) and 21 patients had reopened FTMHs after initially successful surgery (reopened group).


METHODS
All patients underwent a second pars plana vitrectomy. Autologous platelet concentrate and perfluoropropane endotamponade were used. Internal limiting membrane peeling was carried out in selected cases. Patients were instructed to maintain a face-down position for 2 weeks after the surgery.


METHODS
Anatomic and visual results.


RESULTS
All patients in the reopened group and 76% of patients in the unclosed group achieved successfully closure of the FTMH after the second surgery. Mean decimal Snellen visual acuity (VA; +/-standard deviation [SD]) before the second surgery was 0.14+/-0.10 (range, 0.01-0.33) in the reopened group and 0.10+/-0.07 (range, hand movements [HM]-0.33) in the unclosed group. The best VA was achieved after cataract surgery; the mean best VA (+/-SD) in the reopened group was 0.42+/-0.31 (range, 0.05-1) and in the unclosed group was 0.19+/-0.14 (range, HM-0.66).


CONCLUSIONS
Reoperating on reopened FTMH resulted in 100% anatomic closure and significant improvement in vision. In contrast, reoperating on patients with initially unsuccessful surgery resulted a lower anatomic closure rate and relatively poor final vision even if their macular holes were closed successfully. This information may help surgeons and patients decide whether to undertake a second operation.
Valldeperas
Xavier
X
Royal Liverpool University Hospital, Liverpool, United Kingdom.
Wong
David
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets; D003657:Decision Making; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
D005466:Fluorocarbons; C042852:perflutren