The presence of a macular hole associated with a retinal detachment is an uncommon situation. This association can be found in two completely different scenarios. The first one, in highly myopic patients, usually with posterior staphiloma in which the macular hole is the primary cause of the detachment. These detachments are sometimes only confined to the posterior pole and they usually have a slow progression over time and no tendency to PVR. The second scenario is present in patients with reghmatogenous retinal detachment complicated by a concomitant macular hole that developed after the retina detached. In these cases the association with PVR at the moment of diagnosis is high, and even if in some cases the detachment can be cured only by a buckle, they usually require vitrectomy for their resolution. The present analysis is made over patients with this second scenario. In a case series of 280 patients that were operated consecutively for RRD we found a concomitant macular hole in 5 (1.78%). At the time of surgical repair, three of these patients had PVR B, in one case associated with a severe choroidal detachment and hypotony, and one of them had PVR C. This confirms the already reported high prevalence of PVR when a macular hole develops in the presence of a RRD. In our five patients a vitrectomy with ILM peeling around the hole, PFO injection, laser photocoagulation of the peripheral tear with fluid-air exchange and SF6 endotamponade was performed. The rate of closure was 100% but final visual acuity remained between 20/200 and 20/50. Post-operative OCTs revealed interruption of ELM and ellipsoid lines, that could explain the moderate final VA restoration found in these patients. In conclusion RRDs with concomitant macular hole are a relatively rare condition, usually associated with moderate to severe PVR grades. In our series, MH closure after vitrectomy and ILM peeling was high, nevertheless changes in external layers of the retina precluded good VA restoration.



Mariano IROS, Gerardo ORMAECHEA
Email : ma_iros@hotmail.com
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