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Br J Ophthalmol. 2007 June; 91(6): 844–845.
PMCID: PMC1955587

Secondary paracentral retinal holes after removal of the internal limiting membrane

We read with interest the article by Steven et al1 on their finding of secondary paracentral retinal holes after internal limiting membrane (ILM) peel. We have also reported on four eyes of four patients that developed iatrogenic eccentric macular holes after vitrectomy with ILM peeling for idiopathic macular holes.2 In their report, Steven et al treated three of the seven patients with argon laser photocoagulation. Haritoglou et al3 reported paracentral scotomata after vitrectomy with ILM peeling for macular holes. Treatment of these paracentral holes with argon laser photocoagulation could therefore make these scotomas worse. The pathogenesis of these iatrogenic holes is unclear. We believe that there must be an element of mechanical trauma involved in the formation of these secondary holes, despite the fact that it is not visible at the time of surgery. Their speculation of weakening of the glial structure of the retina caused by decapitation of the Muller cells is interesting and may also play an important role, as all the holes reported are in the ILM‐denuded area. We note that, in the series by Steven et al, all the reported holes appear temporal to the fovea. In our series, the holes were reported inferior as well as nasal to the fovea. We used trypan blue to assist in the peeling of the ILM, and no obvious areas of retinal trauma were apparent at the time of surgery. The secondary holes became apparent in the follow‐up period; none of them have had any treatment and have not caused any problems after long‐term follow‐up (6 years). We recommend that these holes should not be treated, as they do not appear to lead to retinal detachment.


1. Steven P, Laqua H, Wong D. et al Secondary paracentral retinal holes following internal limiting membrane removal. Br J Ophthalmol 2006. 90293–295.295 [PMC free article] [PubMed]
2. Rubinstein A, Bates R, Benjamin L. et al Iatrogenic eccentric full thickness macular holes following vitrectomy with ILM peeling for idiopathic macular holes. Eye 2005. 191333–1335.1335 [PubMed]
3. Haritoglou C, Ehrt O, Gass C A. et al Paracentral scotomata: a new finding after vitrectomy for idiopathic macular hole. Br J Ophthalmol 2001. 85231–233.233 [PMC free article] [PubMed]

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