Secondary Macular Hole After Diabetic Vitrectomy

Postvitrectomy macular hole (MH) has been reported after surgery for rhegmatogenous retinal detachment (RRD), epiretinal membrane (ERM), or myopic tractional maculopathy, with incidence rates ranging from 0.2% to 1.9% (Garcia-Arumi et al., Retina 31(9):1777–1782, 2011; Fabian et al., Retina 32(3):511–519, 2012; Medina et al., Retina 37(6):1065–1072, 2017; Rush et al., Retina 34(5):890–896, 2014; Kang et al., Sci Rep 9(1):19535, 2019; Gaucher et al., Am J Ophthalmol 143(3):455–462, 2007). The possible mechanisms include iatrogenic trauma or microhole formation during the induction of posterior vitreous detachment (PVD) or membrane peeling, cystoid macular edema (CME), tangential traction caused by residual posterior hyaloid (PH) or ERM, and underlying macular weakening. Secondary MHs may have distinct pathogenesis and clinical manifestations depending on the underlying disease. Few studies have been performed to specifically investigate postoperative MH after diabetic vitrectomy (DV). In this chapter, the various clinical manifestations, surgical choices, and outcomes are discussed.