Vision-threatening complications of surgery for full-thickness macular holes

Objective: To study complications of vitrectomy surgery for full-thickness macular holes. Design: A multicentered, randomized, controlled clinical trial. Participants: Community and university-based ophthalmology clinics. Intervention: Standardized macular hole surgery versus observation. Main Outcome Measures: Assessment of anatomic and visual outcomes and determination of postoperative complications at 12 months after randomization. Results: Posterior segment complications were noted in 39 eyes (41%). The incidences of retinal pigment: epithelium (RPE) alteration and retinal detachment (RD) were 33% and 11%, respectively. One RD due to a giant retinal tear resulted in a visual acuity of light perception. Other complications included a reopening of the macular hole in 2 eyes (2%), cystoid macular edema in 1 eye (1%), a choroidal neovascular membrane in 1 eye (1%), and endophthalmitis in 1 eye (1%). Eyes with complications had significantly worse visual acuity outcomes as determined by the Early Treatment Diabetic Retinopathy Study, Word Reading, and Potential Acuity Meter charts (P < 0.01 for all comparisons). Eyes with macular holes greater than 475 mu m were more than twice as likely to have complications than eyes with holes less than 475 mu m (odds ratio [OR] = 2.2, P = 0.07). Before surgery, the stage of the hole was related to postoperative RPE changes (P < 0.0001) and the occurrence of postoperative RD (P = 0.0002). Intraoperative trauma was related to the occurrence of these complications (P < 0.0001 for RPE changes, P = 0.02 for RDs). Epiretinal membrane removal was related to RPE changes (P = 0.02) but not RDs. Conclusions: The RPE alterations and RDs are common after macular hole surgery and result in significantly reduced postoperative visual acuity. The RPE changes may be related to surgical trauma or light toxicity, Further efforts to reduce complications associated with macular hole surgery are indicated.