Abstract
BackgroundRetinal detachment (RD) secondary to macular hole (MH) is a common complication in highly myopic eyes, usually leading to a poor visual prognosis. The purpose of this study was to evaluate the surgical outcome of silicone oil (SO) tamponade and internal limiting membrane (ILM) peeling in the treatment of RD caused by MH (MHRD) in highly myopic eyes with chorioretinal atrophy, and to identify clinical factors associated with the anatomical outcomes.MethodsWe retrospectively reviewed 21 eyes of 21 highly myopic patients affected by RD secondary to MH and chorioretinal atrophy. All eyes were treated with pars plana vitrectomy (PPV) with ILM peeling and SO tamponade. Anatomical success was defined as reattachment of the retina with the closure of the MH, as assessed by optical coherence tomography (OCT), after SO removal. Logistic regression was performed to determine the clinical factors influencing anatomical success.ResultsThe mean patient age was 59.95 years [standard deviation (SD), 10.39; range, 34–77 years] and the mean axial length was 30.58 mm (SD, 1.52; range, 27.99–34.51 mm). After the first surgical procedure, the anatomical success rate was 61.9 % (13 eyes in 21 eyes), with initial retinal attachment of16 eyes (76.2 %). A second surgical approach was performed for the five eyes with persistent or recurrent RD, and the final retinal reattachment rate was 100 % (21/21). Logistic regression analysis showed that no specific factors were significantly associated with anatomical success.ConclusionsPrimary silicone oil tamponade and ILM peeling can be a practical treatment for repairing MHRD in highly myopic eyes with chorioretinal atrophy.
Highlights
Retinal detachment (RD) secondary to macular hole (MH) is a common complication in highly myopic eyes, usually leading to a poor visual prognosis
We retrospectively reviewed highly myopic MHRD patients with patchy chorioretinal atrophy (PCA) around the MH who had been treated with pars plana vitrectomy (PPV), internal limiting membrane (ILM) peeling, and primary silicone oil tamponade
The inclusion criteria were: (1) patients with clinical presentation of RD caused by a MH in a myopic eye [refractive error >−6.00 diopters (D) and axial length (AXL) > 26.5 mm]; (2) treatment with a 23-gauge 3-port PPV with the ILM peeling and primary silicone oil tamponade; (3) a postoperative follow-up period more than 6 months after the primary vitrectomy; and (4) the existence of PCA on the background of the MH in the surgical eye
Summary
Retinal detachment (RD) secondary to macular hole (MH) is a common complication in highly myopic eyes, usually leading to a poor visual prognosis. The purpose of this study was to evaluate the surgical outcome of silicone oil (SO) tamponade and internal limiting membrane (ILM) peeling in the treatment of RD caused by MH (MHRD) in highly myopic eyes with chorioretinal atrophy, and to identify clinical factors associated with the anatomical outcomes. The precise pathogenic mechanism underlying the condition remains unclear. Many factors such as anteroposterior/tangential vitreous traction, posterior staphyloma, and chorioretinal atrophy have been proposed as contributing to its onset [1, 2]. Many surgical approaches have been used to repair MHRD in highly myopic eyes, including pneumoretinopexy, pars plana vitrectomy (PPV) with gas, silicone oil (SO) or heavy SO tamponade, and macular buckling (MB) [2, 4].
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