title: INDUCTION OF MACULAR DETACHMENT FOR THE TREATMENT OF PERSISTENT OR RECURRENT IDIOPATHIC MACULAR HOLES.
abstract: OBJECTIVE
  To analyze the efficacy of induced macular detachment for the treatment of persistent or recurrent idiopathic macular holes after treatment with one or more standard pars plana vitrectomies (PPVs) with internal limiting membrane peeling.
  
  
  METHODS
  This study is a retrospective consecutive case series of 10 patients who underwent a PPV with subretinal balanced salt solution injection from 2011 to 2014 to treat persistent or recurrent idiopathic macular holes. All patients had previously undergone PPV with internal limiting membrane peeling. Visual acuity, ocular examination findings, and optical coherence tomographic images were reviewed preoperatively and postoperatively to assess the anatomical and visual outcomes of this procedure.
  
  
  RESULTS
  Nine of the 10 patients who underwent the procedure had closure of their macular holes postoperatively (90%) and remained closed 6 months postoperatively. Most patients reported a subjective visual improvement. A mean objective visual improvement of 16 letters (Early Treatment Diabetic Retinopathy Study, 0.324 logMAR) was seen between preoperative and 6-month postoperative assessments of all patients (pre = 1.490, post = 1.166; P = 0.022). Subgroup analysis of patients with successful closure revealed 20 letters of improvement (0.398 logMAR) in visual acuity (pre = 1.491, post = 1.093; P = 0.004). There were no intraoperative or postoperative complications.
  
  
  CONCLUSIONS
  In eyes with persistent or recurrent idiopathic macular holes after standard PPV with internal limiting membrane peeling, repeat PPV with subretinal balanced salt solution injection to create a macular detachment may be a viable surgical treatment option. Our results show improved anatomical and visual outcomes postoperatively that compare favorably to other case series describing various surgical treatments for these challenging cases.
authors: *Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; †Department of Visual Sciences, University of Arizona, Tucson, Arizona; ‡Department of Visual Sciences, Retina Associates Southwest, University of Arizona, Tucson, Arizona; and §Department of Ophthalmology and Vision Sciences, Krembil Neuroscience Centre, University of Toronto, Toronto, Ontario, Canada.
authors: Andrei-Alexandru
authors: AA
authors: Szigiato
authors: Fatimah
authors: F
authors: Gilani
authors: Mark K
authors: MK
authors: Walsh
authors: Efrem D
authors: ED
authors: Mandelcorn
authors: Rajeev H
authors: RH
authors: Muni
mesh_terms: D000085:Acetates / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery*; D004338:Drug Combinations; D058450:Endotamponade; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000008:administration & dosage*; D016684:Prone Position; D012008:Recurrence; D012160:Retina / Q000503:physiopathology / Q000601:surgery*; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
chemical_list: D000085:Acetates; C030660:BSS solution; D004338:Drug Combinations; D005466:Fluorocarbons; D008903:Minerals; D012965:Sodium Chloride; C042852:perflutren