Hager A., Ehrich S., Wiegand W.

Eye Department, Klinikum Nord-Heidberg, Tangstedter Landstr. 400, 22413 Hamburg

Objective: The spectrum of reoperations after macular surgery is investigated in a larger group of patients. All secondary surgical procedures except for cataract extraction are considered.
Methods: Between 1995 and 2000 350 eyes underwent macular surgery (212 due to macular pucker, 138 due to macular hole) with a standard 3- port-pars-plana vitrectomy, creation of vitreous detachment, membrane peeling and SF6-instillation without any other adjuncts. The vitrectomies were performed by 4 different surgeons. In all patients a preoperative circular peripheral cryoretinopexy was performed 3-4 weeks ahead of macular surgery. Postoperative controls were performed with a follow-up of at least 6 months. The number of necessary vitreoretinal reoperations and the postoperative rate of retinal detachment were analized.
Results: In 18 cases (5.1%) a second vitrectomy had to be performed due to a unsatisfying postoperative macular finding: 8/212 (3.8%) after macular pucker with a recurrent pucker and 10/138 (7.2%) after macular hole surgery with persistent macular hole. In 8/350 (2.3%) a postoperative rhegmatogenous retinal detachment was observed, 4 of these patients received a buckling procedure and in 4 eyes one or more additional vitrectomies had to be performed.
Conclusion: In our study in 26/350 eyes (7.4%) another vitreoretinal procedure was necessary after macular surgery had been performed. In 8 cases (2.3%) this was caused by a vision threatening postoperative retinal detachment. This detachment rate is considerably lower than in most other studies. Therefore, a possible prophylactic effect of the preoperative circular peripheral cryoretinopexy is suggested to lower the risk of postoperative retinal detachment.

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