PROLIFERATIVE VITREORETINOPATHY MAY BE A RISK FACTOR IN COMBINED MACULAR HOLE RETINAL DETACHMENT CASES MATTHEW A. CUNNINGHAM, MD,* RYAN M. TARANTOLA, MD,† JAMES C. FOLK, MD,* ELLIOTT H. SOHN, MD,* H. CULVER BOLDT, MD,* JORDAN A. GRAFF, MD,§ KORIANNE ELKINS, MD,¶ STEPHEN R. RUSSELL, MD,* VINIT B. MAHAJAN, MD, PHD*‡ Objective: To review the incidence and closure rate of full-thickness macular holes (MH) in cases associated with concomitant rhegmatogenous retinal detachment (RRD). Methods: A retrospective consecutive case series was performed from patients undergoing surgical repair of RRD and simultaneous closure of MH. The presence of proliferative vitreoretinopathy (PVR), rates of hole closure and reattachment, and visual acuity outcomes were evaluated. Results: There were a total of 607 RRDs during the study period. The incidence of concomitant MH in RRD cases was 2.3% (14 of 607), and the overall incidence of PVR was 15.8% (96 of 607). All eyes with a MH had a primary break that was distinct from the MH. Five patients did not meet the inclusion criteria for review of the postoperative outcomes. In the remaining 9 patients, the retinal reattachment rate was 100%, and MH closure was achieved in 8 of 9 (89%) eyes after a single surgery. At the time of primary repair, PVR was present in 6 of these 9 cases (66.7%). There was a significant association between the presence of PVR and a concomitant MH (P = 0.0027). The mean preoperative visual acuity was 2.59 ± 0.649 logarithm of the minimum angle of resolution units and significantly improved to 1.23 ± 1.01 logarithm of the minimum angle of resolution units (P = 0.00124). Overall, 88.8% of patients showed an improvement in visual acuity at the final postoperative visit, and a visual acuity of 20/125 or better was achieved in 66.7% of cases. Conclusion: Macular holes combined with a RRD are infrequent, and good anatomical results can be achieved after a simultaneous repair. Also, PVR may be more frequently encountered in this particular subset of RRDs. RETINA 33:579–585, 2013 R etinal breaks typically develop during the separa- tion of the vitreous from the retina during posterior vitreous detachment. Common locations include sites in the retinal periphery where vitreoretinal adhesion is strong, such as at the vitreous base and areas of lattice degeneration. Strong vitreoretinal adhesion in the peri- fovea can lead to macular holes (MH), which represent a unique class of retinal breaks, 1–3 occurring at the fovea with significantly less subretinal fluid than that associated with a typical rhegmatogenous retinal detachment (RRD). Most MHs are idiopathic, but some develop secondary to trauma, 4 after vitrectomy, 5 or in highly myopic patients. 6–8 The simultaneous occurrence of a MH and RRD is uncommon. 9 Tangential traction from epiretinal membranes can also contribute to the formation of retinal breaks. For example, proliferative vitreoretinopathy (PVR) remains the most common cause of failure in RRD repair, and its From the *Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa; †Vitreoretinal Service, Department of Ophthalmology, Saint Louis University Eye Institute, Saint Louis, Missouri; ‡Omics Labo- ratory, The University of Iowa, Iowa City, Iowa; §Barnet Dulaney Perkins Eye Center, Phoenix, Arizona; and ¶Tidewater Eye Center, Chesapeake, Virginia. Supported in part by an unrestricted grant from the Research to Prevent Blindness, Inc, New York, NY. The authors have no commercial or financial interests to disclose. Reprint requests: Vinit B. Mahajan, MD, PhD, Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242; e-mail: mahajanlab@gmail.com 579