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Eric Ezra, FRCS, FRCOphth; William G. Aylward, FRCS, FRCOphth; Zdenek J. Gregor, FRCS, FRCOphth

Arch Ophthalmol. 1997;115(10):1276-1280.

Abstract
Objective
To determine the efficacy of reoperation with rigorous epiretinal membrane dissection and autologous serum for full-thickness macular holes remaining open after initial surgery.

Methods
Forty-six consecutive eyes that had previously undergone unsuccessful macular hole surgery were re-treated with epiretinal membrane dissection, adjunctive autologous serum, and 16% perfluoropropane (C₃F₈) gas tamponade. Anatomical closure and improvement of best-corrected Snellen visual acuity were used as outcome measures, and nuclear sclerosis was graded clinically before and after reoperation.

Results
Epiretinal membrane was identified and dissected in 29 (63%) of the 46 eyes and anatomical closure was achieved in 37 (80%) of the 46 eyes. Of these, 23 (62%) of 37 improved by at least 2 Snellen lines, 12 (35%) of 37 by at least 3 Snellen lines, and 6 (16%) of 37 by at least 4 Snellen lines. Increase in nuclear sclerosis occurred in 30 (65%) of the 46 eyes postoperatively, leading to cataract extraction in 12 (26%) of the eyes at last follow-up (mean, 10.3 months). A longer total duration (P<.001) and a worse preoperative visual acuity (P=.001), prior to reoperation, were associated with a worse final visual acuity after surgery.

Conclusions
Retreatment with rigorous membranectomy and autologous serum seems to be beneficial in most eyes in which initial macular hole surgery has failed. Although the anatomical closure rate is similar to that reported after primary surgery, final visual acuity improvement seems to be less than after successful primary closure, owing to the longer mean duration of holes in which initial surgery has failed.

Author Affiliations
From the Vitreoretinal Unit, Moorfields Eye Hospital, London, England.

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