title: RECURRENT MACULAR HOLES IN THE ERA OF SMALL-GAUGE VITRECTOMY: A Review of Incidence, Risk Factors, and Outcomes.
abstract: OBJECTIVE
  To evaluate the preoperative features, intraoperative management, and postoperative outcomes of recurrent macular holes that developed after initial successful repair with small-gauge vitrectomy techniques.
  
  
  METHODS
  We retrospectively reviewed 392 eyes with idiopathic macular holes successfully treated with small-gauge vitrectomy. Thirteen of these eyes underwent reoperation after macular hole reopening. We assessed patient demographics, visual acuity, postoperative anatomical success, potential precipitating clinical factors of hole reopening, and details of the surgical repairs of these eyes.
  
  
  RESULTS
  Macular hole reopening occurred in 13 (3.3%) of 392 eyes in a mean of 28 months (range, 1-120 months) after initial repair. All 13 recurrent holes closed after a second vitrectomy, but 4 (31%) holes reopened again and had vitrectomy. Of these, 2 reopened a third time. Ultimately, 11 (85%) holes were closed at the most recent follow-up. The mean best-corrected visual acuity was 20/81 before initial repair, 20/148 after the first reopening, 20/115 after repair of the first reopening, and 20/55 after repair of >1 reopening. Ten of 13 (77%) patients had, or later developed, macular holes in the other eye during follow-up.
  
  
  CONCLUSIONS
  Reoperation successfully achieved hole closure and ultimate visual improvement in most eyes with recurrent macular holes. Most patients with recurrent holes previously had, or later developed, full-thickness macular holes in the other eye.
authors.affiliation: *Texas Retina Associates, Dallas, Texas; †Department of Ophthalmology, University of Texas Southwestern Medical Center; ‡Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan; §Retina Consultants of Houston, Houston, Texas; and ¶Associated Retinal Consultants, Royal Oak, Michigan.
authors.forename: Ashkan M
authors.initials: AM
authors.lastname: Abbey
authors.forename: Lily
authors.initials: L
authors.lastname: Van Laere
authors.forename: Ankoor R
authors.initials: AR
authors.lastname: Shah
authors.forename: Tarek S
authors.initials: TS
authors.lastname: Hassan
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012008:Recurrence; D012086:Reoperation; D012167:Retinal Perforations / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*