Korean J Ophthalmol.  2012 Oct;26(5):355-361. 10.3341/kjo.2012.26.5.355.

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

• Heo MS
• Kim HW
• Lee JE
• Lee SJ
• Yun IH

• KMID: 1397486
• DOI: http://doi.org/10.3341/kjo.2012.26.5.355

Abstract

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.

Keyword

Macular pucker; Pars plana vitrectomy; Rhegmatogenous retinal detachment

MeSH Terms

Adolescent
Adult
Aged
Chi-Square Distribution
Epiretinal Membrane/*pathology/surgery
Female
Humans
Male
Middle Aged
Postoperative Complications
Reoperation
Retinal Detachment/*surgery
Retrospective Studies
Risk Factors
Statistics, Nonparametric
Visual Acuity
Vitrectomy/*methods

Figure

• 

  Fig. 1 The visual acuity (VA) and central macular thickness (CMT) of the clinically followed macular pucker group and the surgically-treated macular pucker group. There was no gross change of VA and a slight decrease of CMT in the non-surgically-treated group. However, in the surgically-treated group, we observed a significant improvement of VA from 0.94 (logarithm of the minimum angle of resolution [logMAR]) to 0.57 (logMAR), and there was considerable improvement of CMT from 470.7 µm preoperatively to 283.6 µm three months postoperatively. This shows the direct correlation between VA and CMT in the macular pucker group. ERM = epiretinal membrane.

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