Postoperatively persistent macular holes after primary vitrectomy are a rare but regular finding. The strategy for further treatment of these cases is still under debate and ample treatment recommendations have been published. We analysed the outcome of untreated persistent macular holes as well as after gas injection or second vitrectomy with different endotamponades.

Methods:

In a retrospective case control study we analysed the anatomic status of the macular hole and the visual acuity in 23 cases with a persistent macular hole after previous initial vitrectomy. Seven patients, who refused further surgery and remained untreated, were used as a control group. Three patients just received a second intravitreal gas-tamponade without further surgical manipulation. The majority of patients (13 eyes) received a second vitrectomy with endotamponade. Additional intraoperative manipulations were autologous blood on the macular hole in 4 cases and revision of the inner limiting membrane peeling in the macula in 9 cases.

Results:

Without further treatment, none of the persistent macular holes closed spontaneously. These eyes showed a statistically not significant (p=0.56) further decrease in LogMAR visual acuity from1.14 ± 0.25 to 1.25 ±0.59 over a mean follow-up of 17.2 months. Solely secondary gas injection never induced a closure of the macular hole. After a mean follow up of 8.5 months the LogMAR visual acuity dropped in these cases statistically not significant from 0.8 ±0.17 to 0.94 ±0.1 (p=0.5). Revision-vitrectomy showed a 61% anatomical closure rate. In eyes with a finally closed macular hole LogMAR visual acuity increased significantly from 0.82 ±0.3 to 0.40 ±0.33 (p=0.016) after a mean follow-up of 15.8 months. When the second treatment attempt was again unsuccessful, LogMAR visual acuity decreased insignificantly from 0.97 ±0.27 to 1.08 ±0.25 (p=0.27) during a mean follow-up of 14.6 months.

Conclusion:

Without further treatment, patients with postoperatively persistent macular holes will develop a non-significant further deterioration in visual acuity. After a successful secondary surgical closure of the macular hole, the eyes develop an increase in visual acuity, which is comparable to the increase after a successful primary surgery. A failed second treatment attempt induces no further deterioration in visual acuity.