Purpose: To report the prevalence and visual outcome of macular epiretinal membranes, pucker and hole occurring after successful surgery for retinal detachment and to analyze the factors associated with its development.
Methods: The charts of 233 successful cases of retinal detachment surgery were retrospectively reviewed for postoperative status of the macula. Scleral buckling surgery was performed in 162 eyes and pars plana vitrectomy was performed in 71 eyes with Proliferative vitreoretinopathy (PVR), Giant retinal tears and posterior retinal breaks other than macular holes. Data obtained preoperative, intraoperative and during postoperative follow-up period of 6 months were analyzed for factors associated with postoperative macular epiretinal membranes, pucker and hole.
Results: The prevalence rate of postoperative macular pucker was 11.16% (26 of 233 eyes). Six cases of macular pucker occurred after scleral buckling 3.70% (6 of 162 eyes) and 20 cases occurred after pars plana vitrectomy 28.17% (20 of 71 eyes) p < 0.001. Fifteen of the 26 eyes were new cases of macular pucker. Macular hole occurred in seven of the 26 eyes. No statistically significant preoperative or intraoperative parameters were found in the scleral buckle group. In the vitrectomy group, postoperative macular pucker was 4.4 times as likely to develop in eyes with preoperative macular pucker compared with eyes that have no preoperative pucker (p = 0.010). Giant retinal tears or multiple retinal breaks were more prevalent in eyes with postoperative pucker. Severe vitreous haze (p = 0.015), PVR stage C3 (p = 0.005) and PVR stage D (p = 0.049) were found to be statistically significant risk factors for postoperative macular pucker. Intraoperative retinectomy was significantly less prevalent in eyes with postoperative macular pucker that developed macular hole. Postoperative visual acuity was significantly better if the macula is not puckered.
Conclusion: Macular epiretinal membranes can occur after successful surgery for retinal detachment and are more prevalent after vitrectomy. Macular pucker and hole lead to deterioration of visual acuity after initial improvement. Identification and removal of all epiretinal membranes and cellular debris from the retinal surface during vitreous surgery may result in less postoperative macular pucker.
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