Secondary paracentral retinal hole following internal limiting membrane peeling for a large macular hole

Main text: A 75-year-old female with a diagnosis of large (basal diameter 1,685 μm) Stage 3 macular hole [Fig. 1a and b] and coexisting epiretinal membrane (BCVA 6/60) underwent uneventful and atraumatic 25 G vitrectomy along with brilliant blue-assisted internal limiting membrane peeling. Postoperative evaluation after 1 month revealed a secondary paracentral retinal hole formation [Fig. 1c and d] along with reduction in the size of the macular hole (BCVA 6/36). Pars plana vitrectomy with internal limiting membrane peeling is the standard technique for the management of large macular holes.[¹] Surgeons performing macular hole should be aware of this relatively rare complication[²³⁴] while performing the procedure. Secondary holes closer to the fovea may require resurgery with gas tamponade.[⁵]

Figure 1: Preoperative colour fundus photograph (a) and optical coherence tomography (b) showing a large macular hole with coexisitng epiretinal membrane. Postoperative colour fundus photograph (c) and optical coherence tomography (d) revealed a secondary paracentral retinal hole with reduction in size of the macular hole

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