Is it worth reoperating on macular holes?

Objective: To evaluate the visual outcome after a second surgical attempt to close idiopathic full-thickness macular holes (FTMH) in patients who underwent unsuccessful primary surgery and in patients with reopened FTMHs. Design: Retrospective single-center case series. Participants: Five hundred thirty-two patients underwent surgery for FTMH in St. Paul's Eye Unit, Liverpool, United Kingdom, between March, 1995, and March, 2005. Fifty-one patients had unclosed FTMHs (unclosed group) and 21 patients had reopened FTMHs after initially successful surgery (reopened group). Methods: All patients underwent a second pars plana vitrectomy. Autologous platelet concentrate and perfluoropropane endotamponade were used. Internal limiting membrane peeling was carried out in selected cases. Patients were instructed to maintain a face-down position for 2 weeks after the surgery. Main Outcome Measures: Anatomic and visual results. Results: All patients in the reopened group and 76% of patients in the unclosed group achieved successfully closure of the FTMH after the second surgery. Mean decimal Snellen visual acuity (VA; +/- standard deviation [SD]) before the second surgery was 0.14 +/- 0.10 (range, 0.01-0.33) in the reopened group and 0.10 +/- 0.07 (range, hand movements [HM]-0.33) in the unclosed group. The best VA was achieved after cataract surgery; the mean best VA (+/- SD) in the reopened group was 0.42 +/- 0.31 (range, 0.05-1) and in the unclosed group was 0.19 +/- 0.14 (range, HM-0.66). Conclusions: Reoperating on reopened FTMH resulted in 100% anatomic closure and significant improvement in vision. In contrast, reoperating on patients with initially unsuccessful surgery resulted a lower anatomic closure rate and relatively poor final vision even if their macular holes were closed successfully. This information may help surgeons and patients decide whether to undertake a second operation. Ophthalmology 2008;115: 158-163 (c) 2008 by the American Academy of Ophthalmology.