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THE ASSOCIATION OF EPIRETINAL MEMBRANE WITH MACULAR HOLE FORMATION AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR

Khurana, Rahul N. MD*,†; Wykoff, Charles C. MD, PhD‡,§; Bansal, Alok S. MD*; Akiyama, Kunihiko MD; Palmer, James D. MD*; Chen, Eric MD‡,§; Chang, Louis K. MD, PhD*; Major, James C. Jr MD, PhD‡,§; Wu, Chengqing PhD**; Wang, Rui BA; Croft, Daniel E. BA; Wong, Tien P. MD‡,§

doi: 10.1097/IAE.0000000000001307
Original Study

Purpose: To describe the clinical and optical coherence tomography findings associated with the development of full-thickness macular holes after rhegmatogenous retinal detachment (RRD) repair.

Methods: Retrospective, interventional case series. All patients who developed full-thickness macular holes after successful RRD repair from 3 clinical practices were reviewed. All cases of combined/simultaneous full-thickness macular hole and RRD were excluded. The main outcome measure was the presence of an epiretinal membrane at time of diagnosis of macular hole.

Results: Twenty-five full-thickness macular holes were diagnosed after successful retinal detachment repair. Surgical approach to RRD repair included pneumatic retinopexy (6, 24%), scleral buckle alone (5, 20%), pars plana vitrectomy only (8, 32%), and combined scleral buckle and pars plana vitrectomy (6, 24%). The preceding RRD involved the macula in 19 patients (76%) before the formation of the macular hole. The median time to full-thickness macular hole diagnosis after RRD repair was 63 days (range, 4–4,080 days). An epiretinal membrane was present in all 25 (100%) macular holes. Two macular holes (8%) spontaneously closed, whereas the other 23 (92%) were successfully closed with a single surgical procedure. Mean visual acuity improved by approximately 5 lines to 20/72 (range, 20/20 to counting fingers at 1 foot) from 20/240 (range, 20/30 to hand motions) after macular hole repair (P < 0.0001).

Conclusion: Full-thickness macular hole formation can occur after all types of RRD repair and is associated with an epiretinal membrane. The epiretinal membrane may play a role in the pathogenesis of secondary macular hole formation after RRD repair.

In this retrospective, interventional case series, 25 full-thickness macular holes were diagnosed after successful retinal detachment repair. All 25 (100%) macular holes were associated with an epiretinal membrane. The epiretinal membrane may play a role in the pathogenesis of secondary macular hole formation after retinal detachment repair.

*Northern California Retina Vitreous Associates, Mountain View, California;

Department of Ophthalmology, University of California, San Francisco, San Francisco, California;

Retina Consultants of Houston, Houston, Texas;

§Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas;

Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan; and

**Celgene Corporation, Berkeley Heights, New Jersey.

Reprint requests: Charles C. Wykoff, MD, PhD, 6560 Fannin Street, Suite 750, Houston, TX 77030; e-mail: ccwmd@houstonretina.com

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

© 2017 by Ophthalmic Communications Society, Inc.