MANAGEMENT OF RHEGMATOGENOUS RETINAL DETACHMENT WITH COEXISTING MACULAR HOLE

In Brief Purpose: To compare the outcomes of vitrectomy with or without internal limiting membrane peeling for rhegmatogenous retinal detachment and coexisting macular hole. Methods: Thirty-one consecutive patients (31 eyes) with macula-off retinal detachment, peripheral breaks and a coexisting macular hole were prospectively enrolled over a 3-year period. All patients underwent vitrectomy with encirclage and gas or silicone oil tamponade. The 17 patients who underwent internal limiting membrane peeling for macular hole constituted Group A and the remaining 14 patients constituted Group B. The main outcome measures were change in best-corrected visual acuity, retinal reattachment, macular hole closure, and type of macular hole closure. Results: The two groups were comparable in preoperative demographics and clinical parameters. The retinal reattachment rate was 100% in both the groups. Macular hole closed in 14 of 17 eyes (82.4%) in Group A and 13 of 14 eyes (92.9%) in Group B (P = 0.607). A flat-open configuration of macular hole closure was observed in 8 of 14 eyes (57%) in Group A and 3 of 13 eyes (27.5%) in Group B (P = 0.188). Mean logarithm of the minimum angle of resolution best-corrected visual acuity improved to 1.0 ± 0.3 (20/200; range, 0.8–1.7) in Group A and 0.6 ± 0.2 (20/80; range, 0.3–1.1) in Group B (P < 0.0001). Ten patients achieved best-corrected visual acuity of ≥20/80 in Group B and none in Group A (P < 0.0001). Conclusion: The anatomical and visual outcomes of vitrectomy without internal limiting membrane peeling in macular hole in retinal detachment were similar to or better than the outcomes obtained with internal limiting membrane peeling. Thirty-one patients (31 eyes) underwent vitrectomy with or without internal limiting membrane peeling for rhegmatogenous retinal detachment and coexisting macular hole. Although retinal reattachment was achieved in all cases, eyes that did not undergo internal limiting membrane peeling had more frequent and complete macular hole closure and greater visual improvement. Internal limiting membrane peeling resulted in more intra/postoperative complications.