The report by Freeman et al1 on "Vitrectomy for the Treatment of Full-Thickness Stage 3 or 4 Macular Holes: Results of a Multicentered Randomized Clinical Trial" in the January 1997 issue of the Archives described a notable incidence of adverse events. One complication, the postoperative appearance of retinal pigment epithelial (RPE) changes causing window defects in the macula in 11 (17%) of 64 patients, is particularly important and intriguing. It is important because a trend toward worsening visual acuity was associated with RPE changes. Of the 20 eyes in the surgery group that had a postoperative decrease in visual acuity, 11 had RPE changes. It is intriguing because this complication is only rarely reported in other large series of macular hole surgery. In fact, an incidence of only 1% was reported in a retrospective study of 98 patients.2
Perhaps the surgical protocol adhered to by the study's investigators
Holekamp NM. Retinal Pigment Epithelial Changes Following Macular Hole Surgery. Arch Ophthalmol. 1997;115(9):1214. doi:10.1001/archopht.1997.01100160384028
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