Macular Hole After Diabetic Vitrectomy
Condition: Proliferative Diabetic Retinopathy; Macular Holes
MeSH terms: Diabetic Retinopathy; Retinal Perforations
Study type: Observational

Summary: 
      To present the clinical characteristics and rational treatment of macular hole (MH) after the
      diabetic vitrectomy (DV) in patients with proliferative diabetic retinopathy (PDR).
    

Detailed description: 
      All patients had received initial vitrectomy to treat complications of PDR. Recruited
      patients were divided to two groups: the persistent MH group, who had MH before the primary
      DV (group 1); and the newly-developed MH group, who developed MH after a successful primary
      DV (group 2). The patients' demographic data, records of ophthalmological examinations, and
      surgical procedures were collected, including best-corrected visual acuity before and after
      each operation, fundus changes, as well as MH repairing techniques. The extent of
      fibrovascular proliferation(FVP) was separated into four grades based on the severity of
      vitreoretinal adhesion : multiple-point adhesions with or without one site plaque-like broad
      adhesion (grade 1), broad adhesions in more than one but fewer than three sites, located
      posterior to the equator (grade 2), broad adhesions in more than three sites, located
      posterior to the equator or extending beyond the equator within one quadrant (grade 3), and
      broad adhesions extending beyond the equator for more than one quadrant (grade 4). The extent
      of retinal detachment (RD) was classified into "within the arcade" or "beyond the arcade".
      The macular structure was evaluated by optical coherence tomography (OCT). All patients had a
      follow-up duration of more than three months after the final surgical procedures.

      Three different surgical techniques were used to treat MH: standard internal limiting
      membrane (ILM) peeling, inverted ILM flap insertion into the MH, and lens anterior or
      posterior capsular flap insertion into the MH. The indication(s) for each technique were:

      standard ILM peeling was performed if no ILM peeling had been done in the previous surgery,
      and the MH size was less than 500um in an attached retina; inverted ILM flap insertion was
      performed if no ILM peeling had been done in the previous surgery, with a detached retina;
      lens anterior capsule flap insertion was performed if cataract surgery was performed in the
      same setting with no ILM tissue available; lens posterior capsule flap insertion was
      performed in a pseudophakic eye with no ILM tissue available. Only descriptive statistics was
      obtained.
    

Intervention name(s): Pars plana vitrectomy
Intervention type(s): Procedure
Intervention description(s): Pars plana vitrectomy combined with Internal limiting membrane peeling, inverted internal limiting membrane flap insertion into the macular hole, or lens anterior or posterior capsular flap insertion into the macular hole
Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients from January 2010 to May 2017 treated by a single surgeon (Y.C.M) at National
        Taiwan University Hospital were retrospectively reviewed.