Institutional members access full text with Ovid®

Share this article on:


Moisseiev, Elad MD*; Fabian, Ido D. MD; Moisseiev, Joseph MD†,‡; Barak, Adiel MD*,‡

doi: 10.1097/IAE.0b013e31828076c5
Original Studies

Purpose: To evaluate the efficacy of repeated pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for persistent macular holes (MHs).

Methods: Twenty-nine eyes that underwent repeated pars plana vitrectomy and internal limiting membrane peeling for persistent MHs were included in this retrospective study. Data retrieved included demographic information, visual acuity before the first and second surgeries, MH diameter before and after both surgical procedures and throughout the follow-up, surgical details, time between surgeries, final visual acuity, and the occurrence of any complications.

Results: Reoperation achieved closure of the persistent MH in 68.9% of the eyes. Final visual acuity improved significantly when compared with that before the second surgery, and postoperative complications were minimal. Reoperation achieved significant improvement in visual acuity (P < 0.001), and 62% of patients gained >2 lines. The final visual acuity was significantly better in eyes with closed MH after the second surgery than that in eyes where it persisted (0.68 ± 0.37 vs. 1.17 ± 0.25 logarithm of the minimum angle of resolution, respectively, P = 0.002). Shorter interoperative time and smaller initial MH diameter were significantly correlated with better visual prognosis (P = 0.029 and 0.005, respectively).

Conclusion: Repeated pars plana vitrectomy with internal limiting membrane peeling and gas tamponade is a safe and effective treatment option for persistent MHs. Earlier reoperation is recommended for greater visual recovery.

This study investigated the treatment of persistent macular holes by reoperation with vitrectomy, internal limiting membrane peeling, and gas tamponade. The second surgery was shown to be a safe and effective treatment for these difficult cases. Better visual results were achieved with early reoperation.

*Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Department of Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Reprint requests: Elad Moisseiev, MD, Department of Ophthalmology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 64239, Israel; e-mail:

None of the authors have any financial/conflicting interests to disclose.

© 2013 by Ophthalmic Communications Society, Inc.