Secondary Full-thickness Macular Holes after Diabetic Vitrectomy: Clinical Manifestations and Rational Approaches to the Treatment

Figure 5

(a-g) A patient (Case 6) has (a, b) grade 2 fibrovascular proliferation (FVP) and tractional retinal detachment (TRD). (c) Eight months after surgery, optical coherence tomography (OCT) shows lamellar macular hole (MH) and epiretinal membrane (ERM). (d, e) A 750-μm MH develops 21 months after cataract operation and silicone oil removal. (f, g) The patient receives ERM removal, internal limiting membrane (ILM) peeling, and temporal inverted ILM flap. The MH is sealed postoperatively. (h-m) A patient (Case 7) who presented with (h) grade 3 FVP and vitreous hemorrhage (VH). (i-k) Lamellar MH and ERM are noted and progress into full-thickness MH at 76 months after the initial surgery. (l, m) After the cataract operation, ERM removal, ILM peeling, and inverted temporal ILM flap, the MH is sealed. (n-t) The patient (Case 8) who presented with (n, o) grade 4 FVP, VH, TRD, and rhegmatogenous retinal detachment. (p, q) OCT shows persistent subretinal fluid and lamellar MH after multiple surgeries for recurrent RD. (r) It progresses into full-thickness MH with RD. Subretinal fibrotic bands are visible on the base of the MH intraoperatively (arrow). (s, t) The MH converts to gap-closure 1 month later.