TITLE: Outcomes of Pars Plana Vitrectomy for Patients with Inflammatory Macular Holes
Natalia F. Callaway1, MD, MS, Marco A Gonzalez1, MD, Efrem Mandelcorn2, MD, Rahul N Khurana3, MD, Phoebe Lin4, MD, PhD, Yoshihiro Yonekawa5, MD, Lucia Sobrin5, MD, MPH, Thomas A Albini1, MD
1 Bascom Palmer Eye Institute at University of Miami Miller School of Medicine, Miami, FL
2 University of Toronto University Eye Clinic, Toronto, ON, Canada
3 Northern California Retina Vitreous Associates, Daly, CA
4 Casey Eye Institute at Oregon Health and Science University, Portland, OR
5 Massachusetts Eye and Ear Infirmary at Harvard Medical School, Boston, MA
PURPOSE: Full-thickness macular hole (FTMH) is a rare complication of uveitis. To date no studies have evaluated surgical outcomes of macular hole repair in this population. The purpose of this study is to evaluate the clinical and optical coherence tomography (OCT) outcomes of pars plana vitrectomy (PPV) for patients with IMH.
METHODS: Non-comparative, interventional, consecutive case series from five vitreoretinal surgical centers from 2007 to 2015: Bascom Palmer Eye Institute, University of Toronto, Northern California Retina Vitreous Associates, Casey Eye Institute and Massachusetts Eye and Ear Infirmary. Cases of full-thickness macular hole attributed primarily to uveitic disease were identified. Patients with significant visual comorbidies such as advanced age-related macular degeneration, glaucoma or proliferative diabetic retinopathy were excluded. Demographic, baseline visual acuity and examination, pre-operative and post-operative OCT at three months, surgical repair technique and lens status were collected. Separate analysis was performed for patients with and without viral retinitis. The primary outcome was visual acuity change. Secondary outcomes were closure of the macular hole and post-operative OCT characteristics.
The study included 18 eyes of 17 patients followed for a mean of 22.3 months (range 21 days – 106 months). The average age of subjects at the time of surgery was 57.4 years old (SD 12.6 years, range 28-75). The most common uveitic causes of IMH were chronic anterior uveitis (16.7%), idiopathic panuveitis (16.7%), and acute retinal necrosis (ARN, 11.1%). At the time of initial surgery for IMH, 13 (72%) of eyes were phakic. Active uveitis was noted during surgery in 28% of eyes.
All eyes underwent standard 3-port PPV with ICG assisted ILM peeling. The pre and post-operative OCT characteristics and visual acuity are shown in Table 1. A significant number of patients had improvement in visual acuity (p=0.04) and all measured OCT characteristics after surgical intervention. All study eyes achieved anatomic closure of IMH by last clinic visit, however, five (28%) required reoperation, 4 for persistent or reopened macular hole and one for proliferative vitreoretinopathy.
CONCLUSIONS: Full-thickness macular hole is a rare complication of inflammatory eye disease. Patients with this complication respond well to traditional surgery.
Abstract Type: 2. #1 Paper, #2 Poster
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