Treatment Outcome of Macular Hole Associated with Rhegmatogenous Retinal Detachment

Background: Macular holes are an infrequent association with rhegmatogenous retinal detachment, increasing the complexity of surgery and affecting outcome.

Aim: To report the visual outcome, macular hole (MH) closure, and retinal reattachment rate after vitrectomy with silicone oil plus different MH closure techniques for MH associated with rhegmatogenous retinal detachment and to compare the visual outcome between the techniques.

Materials and methods: A retrospective, comparative study. Review of pre and postoperative Snellen best corrected visual acuity (BCVA) and the logarithm of minimum angle of resolution (LogMAR) conversion for nine eyes of 9 consecutively treated macular hole in rhegmatogenous retinal detachment patients. Pre and postoperative optical coherence tomography (OCT) macula scans and retinal reattachment three months post silicone oil removal were assessed.

Results: Surgical techniques: Inverted internal limiting membrane flap (n = 4; 44.45%), internal limiting membrane (ILM) plug (n = 4; 44.45%), and autologous retinal transplant (n = 1; 11.1%). Outcome: Single-surgery retinal reattachment rate was 88.9% (8/9 eyes), and 100% with second surgery. Primary MH closure was 100%. One reopened MH with retinal re-detachment, post silicone oil removal, required additional surgery. The mean preoperative BCVA was 2.53 ± 0.93 LogMAR, and mean postoperative BCVA was 0.94 ± SD 0.43 LogMAR (P = 0.000). Mean change in Snellen line = 2.22 ± 1.72. The postoperative vision was the same as preoperative in 22.2% and improved in 77.8%. Mean postoperative vision for the inverted ILM flap group (n = 4) was 1.10 ± 0.62 LogMAR (P = 0.038), and for the ILM plug group (n = 4) 0.83 ± 0.23 LogMAR (P = 0.002). The surgical technique did not influence postoperative BCVA (P = 0.85). Only one eye had an outer retina on OCT evaluation. Complications were macular atrophy (55.6%), macular edema (44.4%), and epiretinal membrane (33.3%).

Conclusion: Single-surgery retinal reattachment rate and macular hole closure using any of the techniques is high, and none showed superiority.