In this interview from the ASRS 2014 Annual Meeting, Dr. Tarek Hassan discusses a retrospective study of the recurrence rate and features of macular holes following small-gauge vitrectomy. The study examined nearly 400 patient cases over a 13-year period and was limited to surgeries performed with 23- or 25-gauge instrumentation. Dr. Hassan and colleagues reported a recurrence rate of 3.3% (13 eyes) compared with an average of 5% to 9% reported in similar studies of recurrent macular holes following 20-gauge vitrectomy. 

Although peeling of the internal limiting membrane (ILM) was standard in each primary operation, in all cases of recurrence, surgeons noted some residual tissue around the hole and secondary peeling was often required. At 1 month postoperatively, the recurrent hole in each of the 13 eyes was closed, but 3 of these subsequently opened at least twice more.

While the reported rate of recurrence is quite low, the study showed that macular holes occur in the fellow eye at an alarming rate of 77%. The finding leads Dr. Hassan to believe that the pathogenesis of macular holes is related to an inherent inelasticity of the ILM in some eyes. If exposed to tangential tractional forces, these eyes may be at greater risk to develop a macular hole.