Table 5.
Literature review — secondary macular hole formation after vitrectomy in different studies.
| Authors, Journal (Year) |
Secondary MH after PPV, Eyes (Incidence) | Mean Age, Years ± SD (Range) | Most Common Diagnosis, Eyes (%) | Mean Interval Between Primary PPV and MH Diagnosis, Month (Range) | ERM/CME Detected Prior to MH Diagnosis, Eyes (%) | High Myopia, Eyes (%) | MH Surgical Outcomes: Successful Closure Rate/Rate of Multiple Operations | Final Visual Outcome, Snellen’s VA (range): Change in VA |
Study Conclusions and Key Findings |
|---|---|---|---|---|---|---|---|---|---|
|
Lee et al.2, Retina (2010) |
10 (0.2% over 5.3 years) |
56 ± 16 (27–78) |
RD 5 (50%); VH due to PDR 4 (40%); Idio-pathic ERM 1 (10%) |
26 (0.6–168) |
ERM 4 (40%)/CME 1 (10%) | 3 (30%) | 9 (90%) closed/0 multiple ops |
20/460 (20/21 to counting fingers): 2-line decrease, 2 eyes (20%) |
Relatively favourable outcomes, final VA dependent on underlying ocular pathology. |
| Garcia-Arumi et al.18, Retina (2011) | 14 (0.6% after RD repair over 13 years) |
52 (29–70) |
Macula-off RD 14 (100%) |
11 (0.8–78) |
ERM 45% overall/CME no data | 3 (21%) | 14 (100%) closed/0 multiple ops | 20/100 (20/28–20/400): 14 (100%) improved compared to pre-op | Favourable MH closure rate, though limited functional VA outcome. |
| Schlenker et al.3, Can J Ophthalmol (2012) | 9 (0.9% after RD repair over 4.5 years) |
49 (9–73) |
RD 9 (100%): macula-off 8 (89%), re-current 5 (56%) |
median 4 (0.07–22) |
ERM 2 (22%)/CME no data | 1 (11%) | 8 (89%) closed/2 (22%) multiple ops |
20/200 (20/50 to counting fingers): 1-line increase, 5 eyes (56%) |
CME may play a prominent role. Favourable MH closure rates, though visual prognosis remains guarded. |
| Fabian et al.8, Retina (2012) | 7 (1.1% after RD repair over 4.5 years) |
60 ± 10 (50–79) |
RD 7 (100%): macula-off 3 (30%) |
20 (1–48) |
ERM 2 (29%)/CME none | (no data) | 5 out of 7 (71%) closed/1 (14%) multiple ops | 20/74 (20/25–20/480): 3 (43%) improved compared to pre-op | Suggests iatrogenic trauma during PPV, vitreoschisis, ILM traction may cause secondary MH. |
| Gao et al.10, Am J Ophthalmol (2013) | 8 (19% after foveoschisis repair over 10 years) |
69 ± 13 (51–83) |
Myopic foveoschisis (100%) |
1.6 (1–3) |
(no data) | Myopia >6D or AXL >26.5 mm: 8 (100%) | (no data) | (no data) | Chorioretinal atrophy/posterior staphyloma not significant. Loss of IS/OS line integrity risk factor for secondary MH development. |
|
Medina et al.11, Retina (2017) |
15 (no data on incidence) |
64 (50–86) |
RD 15 (100%): macula-off 9 (60%), re-current 9 (60%) |
4 (1–13) |
ERM 11 (73%)/CME none | Myopia >6D or AXL >26.5 mm: 5 out of 9 (56%) | 11 (73%) closed/7 (47%) multiple ops | 20/267 (20/60 to hand motions): 2-line increase, 8 eyes (53%) | Secondary MH may be associated with ERM, macula-off RD, recurrent RD, and high myopia. Limited visual improvement even after MH closure. |
|
Khurana et al.14, Retina (2017) |
14 (no data on incidence) |
61 (43–71) |
RD 14 (100%): macula-off RD 6 (43%) |
median 15 (1–78) |
ERM 14 (100%)/CME none | (no data) | 12 out of 12 (100%) closed/0 multiple ops | 20/25 (20/20 to counting fingers): 13 (93%) improved compared to pre-op | ERM may play a role in the pathogenesis of MH. |
|
Kang et al., Present Study |
38 (0.6% over 10 years) |
57 ± 15 (18–77) |
RD 9 (23.7%) with 5 macula-off; secondary ERM 6 (15.8%) |
median 2.3 (0.04–91) |
ERM 19 (50%)/CME none | AXL >28 mm: 6 (15.8%) | 34 out of 36 (94%)/10 (28%) multiple ops | 20/86 (20/25 to counting fingers): 3-line increase, 18 (47%) | Occurs most commonly after RD repair, associated with ERM. AXL ≥28 mm and poor BCVA at 3 months associated with limited outcome. History of macula-off RD risk factor for multiple surgeries for MH closure. |
AXL = axial length; BCVA = best-corrected visual acuity; CME = cystoid macular oedema; ERM = epiretinal membrane; ILM = internal limiting membrane; IS/OS = inner segment/outer segment; MH = macular hole; RD = retinal detachment; PDR = proliferative diabetic retinopathy; PPV = pars plana vitrectomy; SD = standard deviation; VA = visual acuity; VH = vitreous haemorrhage.