J Korean Ophthalmol Soc.  2012 Apr;53(4):597-601.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

Affiliations
  • 1Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea. parasols@hanmail.net

Abstract

PURPOSE
To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery.
CASE SUMMARY
A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole.
CONCLUSIONS
When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

Keyword

Cataract surgery; Cystoid macular edema; Macular hole; Vitrectomized eye

MeSH Terms

Cataract
Eye
Humans
Lens Implantation, Intraocular
Macular Edema
Membranes
Middle Aged
Phacoemulsification
Retinal Perforations
Tomography, Optical Coherence
Vision Disorders
Vitrectomy

Figure

  • Figure 1 Optical coherence tomography before cataract surgery does not show macular edema.

  • Figure 2 Fundus photography (A) and fluorescein angiography (B, C) at 3 months after cataract surgery shows macular hole and cystoid macula edema.

  • Figure 3 Optical coherence tomography shows full thickness macular hole 3 months after cataract surgery.

  • Figure 4 Optical coherence tomography shows closed macular hole with subretinal fluid 3 months after ILM peeling and C3F8 (14%) gas tamponade.


Reference

1. Funata M, Wendel RT, de la Cruz Z, Green WR. Clinicopathologic study of bilateral macular holes treated with pars plana vitrectomy and gas tamponade. Retina. 1992. 12:289–298.
2. Madreperla SA, Geiger GL, Funata M, et al. Clinicopathologic correlation of a macular hole treated by cortical vitreous peeling and gas tamponade. Ophthalmology. 1994. 101:682–686.
3. Gass JD. Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol. 1988. 106:629–639.
4. Bainbridge J, Herbert E, Gregor Z. Macular holes: vitreoretinal relationships and surgical approaches. Eye (Lond). 2008. 22:1301–1309.
5. Gaudric A, Haouchine B, Massin P, et al. Macular hole formation: new data provided by optical coherence tomography. Arch Ophthalmol. 1999. 117:744–751.
6. Azzolini C, Patelli F, Brancato R. Correlation between optical coherence tomography data and biomicroscopic interpretation of idiopathic macular hole. Am J Ophthalmol. 2001. 132:348–355.
7. Tanner V, Chauhan DS, Jackson TL, Williamson TH. Optical coherence tomography of the vitreoretinal interface in macular hole formation. Br J Ophthalmol. 2001. 85:1092–1097.
8. Lister W. Holes in the retina and their clinical significance. Br J Ophthalmol. 1924. 8:i4–i20.
9. Yoshioka H. [Clinical studies on the macular hole. 3. On the pathogenesis of the senile macular hole]. Nihon Ganka Gakkai Zasshi. 1968. 72:575–584.
10. Aaberg TM. Macular holes: a review. Surv Ophthalmol. 1970. 15:139–162.
11. Ho AC, Guyer DR, Fine SL. Macular hole. Surv Ophthalmol. 1998. 42:393–416.
12. Sjaarda RN. Macular hole. Int Ophthalmol Clin. 1995. 35:105–122.
13. Ameli N, Lashkari K. Macular hole following cataract extraction. Semin Ophthalmol. 2002. 17:196–198.
14. Patterson JA, Ezra E, Gregor ZJ. Acute full-thickness macular hole after uncomplicated phacoemulsification cataract surgery. Am J Ophthalmol. 2001. 131:799–800.
15. Smiddy WE. Atypical presentations of macular holes. Arch Ophthalmol. 1993. 111:626–631.
16. Tsujikawa M, Saito Y, Lewis JM, Tano Y. Secondary vitrectomy for the treatment of macular holes occurring after vitrectomy. Ophthalmic Surg Lasers. 1997. 28:336–337.
17. Lipham WJ, Smiddy WE. Idiopathic macular hole following vitrectomy: implications for pathogenesis. Ophthalmic Surg Lasers. 1997. 28:633–639.
18. Shaikh S, Garretson B. Spontaneous closure of a recurrent macular hole following vitrecomy corroborated by optical coherence tomography. Ophthalmic Surg Lasers Imaging. 2003. 34:172–174.
19. Lo WR, Hubbard GB. Macular hole formation, spontaneous closure, and recurrence in a previously vitrectomized eye. Am J Ophthalmol. 2006. 141:962–964.
20. Lee SH, Park KH, Kim JH, et al. Secondary macular hole formation after vitrectomy. Retina. 2010. 30:1072–1077.
21. Yoshida M, Kishi S. Pathogenesis of macular hole recurrence and its prevention by internal limiting membrane peeling. Retina. 2007. 27:169–173.
22. Kumagai K, Ogino N, Furukawa M, et al. Surgical outcomes for patients who develop macular holes after pars plana vitrectomy. Am J Ophthalmol. 2008. 145:1077–1080.
23. Hitchings RA, Chisholm IH, Bird AC. Aphakic macular edema: incidence and pathogenesis. Invest Ophthalmol. 1975. 14:68–72.
24. Irvine AR. Cystoid maculopathy. Surv Ophthalmol. 1976. 21:1–17.
25. Jaffe NS. Vitreous traction at the posterior pole of the fundus due to alterations in the vitreous posterior. Trans Am Acad Ophthalmol Otolaryngol. 1967. 71:642–652.
26. Jaffe NS. Complications of acute posterior vitreous detachment. Arch Ophthalmol. 1968. 79:568–571.
27. Tolentino FI, Schepens CL. Edema of posterior pole after cataract extraction. A biomicroscopic study. Arch Ophthalmol. 1965. 74:781–786.
28. Ray S, D'Amico DJ. Pseudophakic cystoid macular edema. Semin Ophthalmol. 2002. 17:167–180.
29. Brazitikos PD, Stangos NT. Macular hole formation in diabetic retinopathy: the role of coexisting macular edema. Doc Ophthalmol. 1999. 97:273–278.
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