Retinal Detachment due to Macular Hole and Posterior Tears: Risk Factors, Pathogenesis, Clinic, and Management

Abstract

Retinal detachment (RD) due to macular hole (MHRD) and posterior retinal tears are rare but also important clinical conditions in vitreoretinal daily practice. MHRD is frequently associated with high myopia and posterior staphyloma, whereas posterior tear related RD is often associated with secondary pathologies. A gold standard method or algorithm for clinical management is not yet available in such cases. Treatment options include pneumoretinopexy, pars plana vitrectomy, and tamponade injection (gas or silicone oil), epiretinal membrane, and/or internal limiting membrane (ILM), intraoperative retinal laser applications and macular buckling peeling. Each surgical method has several advantages and disadvantages. However, in recent years, successful results regarding ILM peeling and ILM flap applications and the use of high-density silicone oil (HDSO) have been reported. Furthermore, macular buckling has gained popularity again although it is a difficult procedure to perform. In conclusion, retinal detachment cases due to MH and posterior retinal tears are difficult to manage and the surgeon should determine the primary patient-specific approach for each case with minimum risk and maximum success. Prospective, randomized, and controlled trials are critically important to determine the gold standard method in these cases.