Abstract
PurposeTo determine the outcomes of vitrectomy with scleral imbrication in highly myopic eyes with either myopic traction maculopathy (MTM) or macular hole retinal detachment (MHRD).MethodsThe medical records of 17 patients who had undergone vitrectomy with internal limiting membrane (ILM) peeling and scleral imbrication for MTM or MHRD were reviewed. The best-corrected visual acuities (BCVAs), the axial length, the macular hole (MH) closure rate, and the shape of the posterior segment determined by optical coherence tomography were evaluated. Three-dimensional magnetic resonance imaging (3D-MRI) was also performed on five eyes.ResultsThe postoperative BCVA improved significantly from 0.76 ± 0.39 logarithm of the minimum angle of resolution (logMAR) units to 0.53 ± 0.35 logMAR units (P = 0.0004). The axial length decreased from 29.42 ± 1.81 mm to 27.97 ± 1.71 mm at 1 month. The MTM was resolved or decreased in all eyes. The MH was closed in 44 % of the MHRD eyes, and the retina was reattached in all of the MHRD eyes. The horizontal distance between the optic disc and the bottom of the posterior staphyloma was significantly decreased at 1 month (P = 0.012) but not at later times. The 3D-MRI images showed a reduction in the distance between the bottom of the posterior staphyloma and the center of the eye (P = 0.029) and a flattening of the posterior staphyloma (P = 0.010).ConclusionsVitrectomy with ILM peeling and scleral imbrication may be helpful in treating MTM and MHRD by reducing the degree of curvature of the posterior staphyloma.
Highlights
Pathologic myopia is associated with a reduction of visual acuity due to chorioretinal abnormalities including myopic choroidal neovascularization, lacquer cracks, patchy or diffuse chorioretinal atrophy, and pigmentary degeneration [1, 2]
Optical coherence tomography (OCT) has shown that myopic traction maculopathy (MTM) usually begins with macular retinoschisis followed by the development of a foveal detachment and a subsequent macular hole retinal detachment (MHRD) [10, 11]
Recent case series studies showed that vitrectomy with internal limiting membrane (ILM) peeling for MHRD achieved a retinal reattachment rate ranging from 42 to 100 % [14, 15, 17]
Summary
Pathologic myopia is associated with a reduction of visual acuity due to chorioretinal abnormalities including myopic choroidal neovascularization, lacquer cracks, patchy or diffuse chorioretinal atrophy, and pigmentary degeneration [1, 2]. Optical coherence tomography (OCT) has shown that MTM usually begins with macular retinoschisis followed by the development of a foveal detachment and a subsequent macular hole retinal detachment (MHRD) [10, 11]. Vitrectomy with internal limiting membrane (ILM) peeling has been used to treat MTM and MHRD [12,13,14,15]. The postoperative complications after treatments for MTM, such as a macular hole (MH) and MHRD, tend to worsen the visual outcomes [13, 16]. Recent case series studies showed that vitrectomy with ILM peeling for MHRD achieved a retinal reattachment rate ranging from 42 to 100 % [14, 15, 17]
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