Surgical Approach May Reduce Retinal Detachment Rates After Macular Hole Repair

A lamellar macular hole results from the thin lamella layer of the macula separating and lifting up from the layer beneath it.
Small gauge pars plana vitrectomy with internal limiting membrane peeling may reduce rates of retinal detachment following idiopathic macular hole surgery.

Employing small gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling may result in fewer incidence of retinal detachment (RD) after idiopathic macular hole (MH) surgery, according to research presented at the American Society of Retina Specialists 40th annual meeting, held in New York, July 13 to 16, 2022.

Researchers conducted a retrospective case series of adult patients undergoing MH surgery who subsequently developed nontraumatic RD between 2013 and 2021. Inclusion criteria included patients undergoing small gauge (23 G, 25 G), while exclusion criteria included previous MH surgery. 

The researchers found that RD occurred in 4 out of 442 (0.9%) of patients undergoing MH repair. The average age of the patients at initial presentation was 75.5 years (age range 60-80 years). Researchers noted pseudophakia in 2 of the 4 eyes with RD, and lattice degeneration treated with barrier laser in 1 of those 4 eyes. Average inner and outer MH diameters were 379 µm (range 99 µm to 640 µm) and 1520 µm (range: 814 µm to 2529 µm), according to the study.  

During MH surgery, posterior vitreous detachment was present in 2 of the 4 eyes and induced in the 2 other eyes. In 2 eyes, no retinal tears (RT) were observed or induced during MH repair, but an iatrogenic RT occurred in 1 eye and atrophic holes were observed in lattice in another eye. The researchers reported that both eyes were successfully treated with endolaser. In 1 eye, a retinal break was not identified. Instrument size in 3 cases was 23 G and, in the fourth eye, 25 G, according to the report. 

The average follow-up length was 363 days. The average VA improved from 20/125 before MH surgery to 20/70 following RD repair. The team reported that the retina has remained attached in all cases and the MH remained closed in 3 of 4 eyes. Overall, 2 out of 4 fellow eyes experienced successful MH surgery without complications.

“Majority of the retinal detachments occurred within the first postoperative month after MH repair, therefore close follow-up is warranted after MH surgery,” according to the researchers. “Even in the rare cases of RD, patients tended to have good anatomic outcomes with overall improvements in visual acuity. While our results should be interpreted with caution, introduction of small gauge vitrectomy and ILM peel may result in fewer postoperative RD after MH surgery.”

This study was limited by its retrospective design.


Kasetty VM, Monsalve PF, Aye J, et al. Analysis of retinal detachments after pars plana vitrectomy for idiopathic macular holes. Poster presented at: The 40th annual meeting of the American Society of Retina Specialists; June 13-16, 2022; New York. Poster 309