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OUTCOMES OF PARS PLANA VITRECTOMY FOR MACULAR HOLE IN PATIENTS WITH UVEITIS

Callaway, Natalia, F., MD, MS*; Gonzalez, Marco, A., MD*; Yonekawa, Yoshihiro, MD†,‡; Faia, Lisa, J., MD; Mandelcorn, Efrem, D., MD§; Khurana, Rahul, N., MD; Saleh, Mohamed G., A., MD**,††; Lin, Phoebe, MD, PhD**; Sobrin, Lucia, MD, MPH; Albini, Thomas, A., MD*

doi: 10.1097/IAE.0000000000001942
Original Study: PDF Only

Purpose: Inflammatory macular hole is a rare complication of uveitis, and data on surgical outcomes of closure are scarce. The purpose of this study is to evaluate the anatomical and visual outcomes of conventional pars plana vitrectomy for patients with uveitis.

Methods: Noncomparative, interventional, and consecutive case series from 6 vitreoretinal surgical centers from 2007 to 2015. Twenty eyes of 19 patients were included with 4 patients separated as viral retinitis. The primary outcome was change in best-corrected visual acuity at Month 3. Secondary outcomes were closure of the macular hole and postoperative optical coherence tomography characteristics.

Results: All eyes underwent conventional three-port pars plana vitrectomy with indocyanine green–assisted internal limiting membrane peeling. Mean Snellen best-corrected visual acuity improved from 20/200 to 20/63 (P = 0.01 for a difference in logarithm of the minimum angle of resolution) at Month 3. Twelve (75%) of patients achieved 2 or more lines of visual acuity improvement by postoperative Month 3. Surgery resulted in decreased epiretinal membrane (P = 0.002), intraretinal fluid (P < 0.001), subretinal fluid (P = 0.029), central subfield thickness (P < 0.001), and central cube volume (P = 0.041). Surgical intervention achieved anatomical success, as measured by macular hole closure, in 13 (81%) of patients at postoperative Month 3.

Conclusion: Patients with inflammatory macular hole respond well to conventional surgery, with good anatomical and visual acuity outcomes.

Inflammatory macular hole is a rare complication of uveitis that can result in central vision loss. Few research studies exist on surgical outcomes of inflammatory macular hole. This multicenter study represents the largest case series of surgical outcomes for uveitic macular hole and reports improved anatomical and visual outcomes after surgical intervention.

*Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida;

Associated Retinal Consultants, P.C., Royal Oak, Michigan;

Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts;

§Donald K. Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada;

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

**Casey Eye Institute, Oregon Health and Science University, Portland, Oregon; and

††Department of Ophthalmology, Assiut University, Assiut, Egypt.

Reprint requests: Thomas A. Albini, MD, Department of Ophthalmology, Bascom Palmer Eye Institute, 900 NW 12th Avenue, Miami, FL 33136; e-mail: Talbini@med.miami.edu

Supported by grants from the National Institutes of Health (Center Core Grant, P30EY014801), Research to Prevent Blindness, the Department of Defense (W81XWH-09-1-0675), and the Klorfine Foundation (to T.A.A.).

Presented at American Society of Retina Specialists, San Francisco, CA, August 10, 2016; International Uveitis Study Group, Dublin, Ireland, August 19, 2016; Sonoma Eye, Sonoma, CA, February 24, 2017; Duke Advanced Vitreous Surgery Course, Durham, NC, April 22, 2017.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.