Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Retina. 2010 Jul-Aug;30(7):1072-7. doi: 10.1097/IAE.0b013e3181cd4819.
The purpose of this study was to report the incidence and the underlying ocular pathology of a macular hole (MH) that develops in vitrectomized eyes and to evaluate its prognosis.
A retrospective chart review was performed in patients who underwent vitrectomy between March 2004 and June 2009. Cases that developed an MH in vitrectomized eyes were identified, and the data from all ophthalmology examinations were collected. Patients with recurrent MHs after the initial MH surgery were excluded.
We identified 10 cases of secondary MH during a period of 64 months (incidence, 8 of 3,279 [0.24%]). Two cases of secondary MHs were not included in the calculations because the initial vitrectomies were performed before March 2004. The initial vitrectomy was performed on four eyes with vitreous hemorrhage caused by proliferative diabetic retinopathy, three eyes with retinal detachment from high myopia, one eye with combined retinal detachment with uveitis, one eye with rhegmatogenous retinal detachment, and one eye with an epiretinal membrane. The macular pathology identified before MH formation included cystoid macular edema in two eyes, epiretinal membrane in four eyes, and no specific lesion in another four eyes. The secondary MHs were managed by additional vitrectomy, peeling of the internal limiting membrane, and intravitreal gas tamponade. Nine of 10 eyes achieved hole closure after the secondary surgery, and 8 eyes recovered their previous visual acuity; the other 2 eyes had visual loss within 2 Snellen chart lines, and none of the 9 patients had a recurrence during a mean follow-up of 20.7 months (range, 4-31 months).
The development of secondary MHs after vitrectomy is rare. Pathogenic mechanisms other than idiopathic MH may be involved in these cases. The anatomical and functional outcome of the secondary MHs that developed after vitrectomy was good, although the final visual acuity was dependent on the underlying ocular pathology.
本研究旨在报告在玻璃体切除术后发生的黄斑裂孔（MH）的发生率和潜在眼部病理，并评估其预后。
对 2004 年 3 月至 2009 年 6 月期间接受玻璃体切除术的患者进行回顾性图表审查。确定在玻璃体切除术后眼内发生 MH 的病例，并收集所有眼科检查的数据。排除初次 MH 手术后再次发生 MH 的患者。
在 64 个月的时间内，我们发现了 10 例继发性 MH（发生率为 3279 例中的 8 例[0.24%]）。有 2 例继发性 MH 未纳入计算，因为最初的玻璃体切除术是在 2004 年 3 月之前进行的。最初的玻璃体切除术是为 4 只因增殖性糖尿病视网膜病变引起的玻璃体积血、3 只因高度近视引起的视网膜脱离、1 只因合并葡萄膜炎的视网膜脱离、1 只因孔源性视网膜脱离和 1 只因视网膜内膜病变的眼进行的。在 MH 形成之前，黄斑病理学包括 2 只眼的囊样黄斑水肿、4 只眼的视网膜内膜病变和另外 4 只眼没有特定病变。对继发性 MH 采用了额外的玻璃体切除术、内界膜剥离和眼内气体填充治疗。10 只眼中的 9 只在二次手术后孔闭合，8 只眼恢复了之前的视力；另外 2 只眼视力损失在 2 个 Snellen 图表线内，9 例患者在平均 20.7 个月（4-31 个月）的随访中均无复发。
玻璃体切除术后继发性 MH 的发生较为罕见。这些病例可能涉及除特发性 MH 以外的发病机制。尽管最终视力取决于潜在的眼部病变，但继发性 MH 在玻璃体切除术后的解剖学和功能结果良好。
