Infusion-Induced Macular Holes in Pars Plana Vitrectomy: A Case Series of Six Patients.

Purpose: To describe a series of six cases in which iatrogenic macular holes were induced by the infusion fluid flow of a 25-gauge pars plana vitrectomy (PPV) system.

Methods: This is a retrospective case series of six patients treated at Kresge Eye Institute between 2018 and 2024.

Results: Iatrogenic macular holes caused by infusion fluid flow are a rare complication of PPV. In this series, five out of six patients had a history of diabetes mellitus and proliferative diabetic retinopathy. The majority of these patients were undergoing repair of tractional retinal detachments when the complication occurred. The average patient age was 47 years (range: 32-66 years). Four patients were pseudophakic, and only one had undergone prior vitrectomy. Preoperative visual acuity ranged from 20/50 to hand motion, while postoperative visual acuity ranged from 20/80 to hand motion. Two patients experienced an improvement in visual acuity postoperatively.

Conclusion: This case series highlights the potential risk of macular hole formation due to infusion fluid dynamics during pars plana vitrectomy. In diabetic patients with tractional retinal detachments or significant macular ischemia, we recommend positioning the infusion cannula away from the posterior pole to mitigate the risk of this complication.