Eccentric macular hole formation has been recently described as a complication of macular hole surgery. We have also experienced this complication following epiretinal membrane peeling surgery, suggesting that the development of this entity reflects is related to generic surgical trauma occurring at the posterior pole.
Rubinstein et al1 describe an interesting complication following macular hole surgery, namely the development of an eccentric macular hole. They speculate that the hole develops as a consequence of operative trauma, mostly likely as the result of elevation of the ILM. They note that the four cases in their series had stable outcomes and did not require further intervention.
We have noted a similar complication following epiretinal membrane peeling and found the risk appears higher in eyes operated on by vitreoretinal fellows and have called this syndrome ‘fellow eye syndrome’. We too believe this complication arises as a result of surgical trauma. The patients in our series did not have fluid–air exchange and vital dyes were not used, suggesting that the injury results from excessive manipulation of the epiretinal membrane.
In our series of four eyes, one patient developed two distinct full-thickness eccentric macular defects. Another two eyes developed macular defects in the presence of extensive drusen, suggesting that outer retinal degenerative changes may increase the risk of eccentric macular hole formation (Figure 1).
We agree with Rubinstein that both the anatomical and functional prognosis is excellent and the patients in our series remained asymptomatic.
Rubinstein A, Bates R, Benjamin L, Shaikh A . Iatrogenic eccentric full thickness macular holes following vitrectomy with ILM peeling for idiopathic macular holes. Eye 2005; 19 (12): 1333–1335.
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Polkinghorne, P., Roufail, E. Eccentric macular hole formation associated with macular hole surgery. Eye 21, 122–123 (2007). https://doi.org/10.1038/sj.eye.6702430