The Clinical Features of Macular Pucker Formation after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment Repair

PURPOSE: To investigate the incidence and predisposing factors of macular pucker formation after pars plana vitrectomy in patients who developed primary rhegmatogenous retinal detachment. METHODS: We retrospectively reviewed a consecutive series of 284 eyes in 284 patients who underwent primary retinal detachment repair by pars plana vitrectomy alone between January 1, 2009 and December 31, 2010. Patients with a history of retinal surgery or another visually significant ocular problem were excluded. RESULTS: Postoperatively, of the 264 eyes that completed at least six months of follow-up, 16 (6.1%) eyes developed obvious macular pucker at clinical examination. Of these 16 eyes, ten (70.0%) underwent repeat vitrectomy with membrane peeling for macular pucker removal during the follow-up period. The mean time from primary vitrectomy for the retinal reattachment to the secondary vitrectomy with membrane peeling for macular pucker was 7.9 months. The mean improvement in vision after membrane peeling surgery was 0.37 (logarithm of the minimum angle of resolution). Using an independent t-test, chi-square test, and Mann-Whitney U-test, we found that the number or size of retinal break and vitreous hemorrhage could be significant risk factors of macular pucker. CONCLUSIONS: In our study, 6.1% of eyes which underwent pars plana vitrectomy alone for primary retinal detachment developed a postoperative macular epiretinal membrane. Multiple or large retinal breaks and postoperative vitreous hemorrhage were related to macular pucker formation. Overall, the 70.0% of eyes which underwent secondary vitrectomy with membrane peeling for removal of macular pucker showed a favorable visual outcome.

A Clinical Study of Macular Pucker after Retinal Detachment Surgery

A retrospective analysis of 122 consecutive of rhegmatogenous retinal detatchment cases which obtained successful surgical results was performed. All the cases were followed for longer than 1 year postoperatively. 15 eyes (12.3%) developed macular pucker. There was no significant difference in sex distribution and mean age was 43.7 years. The mean lapse time between surgery and the development of macular pucker was 7.2 months. Significant factors for developing macular pucker were multiple operation, preoperative macular detachment, and duration of retinal detachment (longer than 1 month). Other factors such as subretirial fluid drainage and myopia were not significant. 9 of 15 eyes with macular pucker were treated with vitrectomy and visual acuity improved in 66.7% of surgically treated eyes. These results suggest that success with single surgical procedure, operation before macular detachment, and early treatment of retinal detachment are important for preventing postsurgical macular pucker.

Analysis of iatrogenic retinal breaks compficating pars plana vitrectomy in eyes with idiopathic macular pucker / 眼科

Objective To determine the incidence and risk factors of iatrogenic retinal breaks in eyes undergoing pars plana vit- rectomy for idiopathic macular pucker.Design Retrospective case series.Participant 88 consecutive vitrectomies performed on eyes with idiopathic macular pucker.Method Consecutive vitrectomies performed on eyes with idiopathic macular pucker at Beijing Tongren Eye Center between 2002 and 2006 were retrospectively reviewed.Cases with iatrogenic retinal breaks were recorded and analyzed. Main Outcome Measure Number and location of retinal breaks,and anatomic outcome after surgical managements.Result A total of 88 consecutive vitrectomies were included in the study.Of the 88 eyes,8 eyes had 14 iatrogenic retinal breaks detected,with an aver- age incidence of 9.1%.Peripheral retinal breaks(8.0%)were more common than posterior retinal breaks(1.1%).All peripheral retinal breaks occurred around the selerotomy sites(100%)and the quadrant of predominant hand was involved most commonly(62%).Most of the breaks(88%)were detected during the surgery.All eyes with iatrogenic retinal breaks obtained anatomic retinal reattachment (100%).Conclusion Despite improvements in instrumentation and surgical techniques,iatrogenic retinal break continues to be an im- portant complication of pars plana vitrectomy in eyes with idiopathic macular pucker.This complication tends to occur more commonly at peripheral retina and is mainly selerotomy-related.

Pars Plana Vitrectomy in Pars Planitis and Posterior Uveitis

This study was undertaken to evaluate the effectiveness of pars plana vitrectomy in pars planitis and posterior uveitis. We performed pars plana vitrectomies in consecutive series of 31 eyes with pars planitis and posterior uveitis that were complicated with vitreous opacities, epiretinal membrane formation, tractional retinal detachment and posterior subcapsular cataract. Postoperatively improvement of visual acuity, 2 lines or more in Snellen chart, was noted in 19 eyes(61.2%) with a mean follow-up of 21 months. The inflammatory cells were not visible in anterior chamber or anterior vitreous after 1 month thereafter. In three patients, however, the postoperative visual acuities were worSe due to preoperatively combined cystoid macular edema, macular pucker and tractional retinal detachment. We believe early pars plana vitrectomy before the formation of epiretinal membrane is an important factor in minimizing and postoperative complications.

Pars Plana Vitrectomy in Pars Planitis and Posterior Uveitis

This study was undertaken to evaluate the effectiveness of pars plana vitrectomy in pars planitis and posterior uveitis. We performed pars plana vitrectomies in consecutive series of 31 eyes with pars planitis and posterior uveitis that were complicated with vitreous opacities, epiretinal membrane formation, tractional retinal detachment and posterior subcapsuIar cataract. Postoperatively improvement of visual acuity, 2 lines or more in Snellen chart, was noted in 19 eyes (61.2%) with a mean follow-up of 21 months. The inflammatory cells were not visible in anterior chamber or anterior vitreous after 1 month thereafter. In three patients, however, the postoperative visual acuities were worse due to preoperatively combined cystoid macular edema, macular pucker and tractional retinal detachment. We believe early pars plana vitrectomy before the formation of epiretinal membrane is an important factor in minimizing and postoperative complications.

Surgical Management of Macular Pucker

Macular pucker describes minute radiating retinal folds and a preretinal membrane in the macular area. Macular pucker can cause reduced central vision and metamorphopsia. In this study, vitreous surgery is used to remove epiretinal membrane in 21 eyes (21 patients) with macular pucker. In order of the decreasing frequency, the causes of macular pucker were uveitis (9 eyes, 429%). trauma (5 eyes). idiopathic (4 eyes), retinal detachment (2 eyes) and retinal vascular disorder (1 eye). The results were as follows: 1. Preoperative visual acuity was 0.2 (40/200) or higher in 6 cases (28.6%). Postoperative visual acuity was 0.2 (40/200) or higher in 16 cases (76.2%). 2. The visual acuity was improved in 18 cases (85.7%) after surgery. 3. The eyes with final visual acuity of 0.1 (20/200) or less had severe preexisting macular damage such as degeneration or edema.