Macular hole following vitrectomy for rhegmatogenous retinal detachment: a comparative study of epiretinal membrane-related factors.

PURPOSE: To investigate macular hole (MH) development after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) and identify epiretinal membrane (ERM)-related factors contributing to MH formation.

STUDY

DESIGN

Retrospective case series.

METHODS

A retrospective analysis was performed on patients who underwent vitrectomy for RRD between January 2008 and December 2022 and subsequently developed ERM or MH requiring secondary surgery. Patients were categorized into two groups: ERM with MH progression (MH group, n=15) and ERM only (ERM group, n=25). Medical records were reviewed to identify potential risk factors including patient demographics, preoperative clinical findings, central macular thickness (CMT), and ERM characteristics using optical coherence tomography (OCT).

RESULTS

CMT measured after ERM occurrence was significantly lower in the MH group (299.23 ± 69.56 μm) compared to the ERM group (445.8 ± 118.34 μm, p < 0.01). The MH group predominantly showed flat foveal contour, whereas the ERM group exhibited significant loss of foveal depression (p < 0.01). Epiretinal proliferation was observed in all MH group cases (100%) versus 24% in the ERM group (p < 0.01). The foveal crack sign was present in 73.3% of MH group cases but absent in the ERM group (p < 0.001).

CONCLUSION

Following successful RRD surgery, the occurrence of MH is a possiblity associated with specific OCT biomarkers. Our findings suggest that centrifugal tangential traction, distinct from conventional centripetal ERM formation, contributes to MH development after RRD repair.