Abstract
PurposeTo compare the anatomical and functional outcomes of macular hole retinal detachment (MHRD) in high myopia after pars plana vitrectomy (PPV) with face-down positioning and adjustable positioning.MethodsFifty-three eyes from 53 patients with MHRD were analyzed in this study. All patients received PPV with silicon oil for tamponade and then subdivided into 2 groups: 28 were included in a face-down positioning group and 25 were included in the adjustable positioning group. Patients were followed up for at least 6 months. The main outcome was the rate of anatomical macular hole (MH) closure and retinal reattachment. Secondary outcome measures were the best-corrected visual acuity and postoperative complications.ResultsThere was no significant difference in the rate of MH closure (53.6 vs. 72.0%, p = 0.167) and retinal reattachment (100 vs. 96%, p = 0.472) between the face-down group and adjustable group. Compared with the mean preoperative best-corrected visual acuity (BCVA), the mean postoperative BCVA at the 6-month follow-up improved significantly in both groups (p = 0, both). But there was no significant difference in the mean postoperative BCVA (p = 0.102) and mean BCVA improvement (p = 0.554) at 6 months after surgery between the two groups. There was no significant difference in the high intraocular pressure (IOP) after surgery between the two groups (53.6 vs. 44%, p = 0.487). There were no other complications that occurred during the follow-up.ConclusionAdjustable positioning after PPV with silicon oil tamponade for MHRD repair is effective and safe. Face-down positioning does not seem to be necessary for all patients with MHRD.
Highlights
Macular hole retinal detachment (MHRD) is a serious vision impairment complication associated with high myopia
The purpose of the current study was to evaluate the 6-month outcomes of adjustable positioning compared to face-down positioning after Pars plana vitrectomy (PPV) for MHRD in high myopia
The inclusion criteria were as follows: [1] eyes with an axial length (AL) ≥26 mm; [2] the diagnosis of MRHD confirmed by optical coherence tomography (OCT) before surgery, and RD extending by more than 1 disk diameter around the full-thickness macular hole (MH); and [3] the follow-up time is more than 6 months
Summary
Macular hole retinal detachment (MHRD) is a serious vision impairment complication associated with high myopia. The weakened retinal adherence to the posterior pole caused by choroidal and retinal pigment epithelium (RPE) atrophy is one of the factors [3]. Since it was first described by Gonvers and Machemer, pars plana vitrectomy (PPV) procedures have been used in the surgical treatment of MHRD with high myopia [4]. Vitrectomy combined posterior vitreous cortex removal, epiretinal membrane removal, and ILM removal, with gas or silicone oil tamponade to become the standard treatment for MHRD with a higher retinal reattachment rate [5]. Since Michalewska et al first presented the inverted ILM flap technique [6], modified techniques, such as temporal ILM flap or inverted ILM insertion, have been introduced to potentially improve the surgical outcomes in MH and MHRD [7–20], or to enhance the success rate in eyes with persistent full-thickness macular hole undergoing secondary PPV [21]
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