Macular Hole In High Myopia Research Articles

Postoperative anatomical and functional outcomes of different stages of high myopia macular hole.

BackgroundRecently it was suggested that high myopia macular holes (HMMH) and macular holes accompanied by retinal detachment occur in the advanced stages of myopia traction maculopathy (MTM), while macular retinoschisis, shallow retinal detachment without holes, and lamellar macular holes occur in the early stages of MTM. Complete vitreous cortex removal associated with internal limiting membrane peeling is now widely used to treat HMMH. However, it remains uncertain at what HMMH stage patients would benefit most from surgical intervention. Our study was aimed to evaluate the postoperative anatomical changes and functional outcomes of high myopia macular holes (HMMH).MethodsPatients were retrospectively collected between March 2009 and August 2011. Before and 1st, 3rd, and 9th month after 23G pars plana vitrectomy, all patients underwent a complete ophthalmologic examination, spectral domain optical coherence tomography (SD-OCT) and MP-1. At each follow-up, best-corrected visual acuity (BCVA), photoreceptor inner and outer segments (IS/OS) defects, and retinal sensitivity (RS) were investigated. According to different preoperative macular hole morphologies, patients were divided into three groups: Group 1, macular hole with epiretinal membrane (ERM) traction and macular retinoschisis; Group 2, full-thickness macular hole (FTMH); Group 3, FTMH with subretinal fluid.Results43 eyes from 43 patients met the inclusion criteria. The mean age was 60 years. BCVA and RS were significantly improved after vitrectomy; the mean IS/OS defect was significantly reduced. At 9 postoperative months, 11 of 43 (25.6 %) eyes achieved IS/OS junction integrity; 9 of these 11 (81.8 %) eyes belonged to Group 1, 2 (18.2 %) belonged to Group 2.ConclusionsPars plana vitrectomy combined with ILM peeling and gas tamponade results in limited functional outcomes in patients with HMMH. The appearance of subretinal fluid indicates a worse prognosis for surgical intervention.

Combined mini-invasive anterior and posterior segment surgery of retinal detachment caused by macular hole in high myopia

Objective To observe the therapeutic effect of combined surgery of 2.2 mm microincision phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy for macular hole retinal detachment in high myopia. Methods A retrospective case series study.Fifty-five eyes of 53 patients with macular hole retinal detachment (MHRD) in high myopia underwent 2.2 mm microincision phacoemulsification combined with 23-gauge vitreoretinal surgery. Postoperatively, the intraocular pressure, best-corrected visual acuity (BCVA), the rate of macular hole closure and retinal reattachment were observed. Results High intraocular pressure (IOP) after surgery were found in 18 eyes accounting for 32.73%. IOP was controlled with drug in 14 eyes, and after silicone oil removal in 2 eyes, and were controlled by trabeculectomy in 2 eyes. BCVA improved in 53 eyes and remained unchanged in 2 eyes. The difference between preoperative and postoperative BCVA was statistically significant(χ2=39.65, P=0.00). The rates of macular hole closure and retina reattachment were 94.55% and 96.36% respectively. Conclusion Combined mini-invasive surgery of anterior and posterior segment is effective on macular hole retinal detachment in high myopia. Key words: Vitreoretinal surgery; Myopia, high; Detachment, retinal, macular hole

A clinical evaluation of combination of vitrectomy and heavy silicone oil tamponade for retinal detachment with macular hole in high myopic eye

Background The surgery for retinal detachment induced by macular hole in high myopic eye has a lower success rate in comparison with other rhegmatogenous retinal detachment.A combination procedure of vitrectomy and heavy silicone oil tamponade for retinal detachment induced by macular hole in high myopic eye has been used,but different outcomes are reported. Objective This study was to assess the efficacy of heavy silicone oil tamponade for the treatment of retinal detachment with macular hole in high myopic eye. Methods The clinical data of 20 eyes of 20 patients who received vitrectomy combined heavy silicone oil tamponade surgery for retinal detachment induced by macular hole in high myopia under the informed consent in Beijing Tongren Eye Center from September 2007 to December 2009 were retrospectively analyzed.The 20 G vitrectomy was used during the surgery.In addition,other procedures,such as epiretinal membrane peeling,retinotomy,endo-laser photocoagulation,phacoemulsification and intraocular lens(IOL) implantation were optionally performed as necessary.No special position was required after the surgery.Heavy silicon oil was removed via pars plana,and retinal reattachment after heavy silicon oil removal was defined as success of surgery.Postoperative LogMAR vision,intraocular pressure,retinal reattachment and complications were observed and evaluated. Results The preoperative average spherical equivalent refractive error was (-14.3±3.0) D in the eyes.Among the 20 eyes,there were 7(35%) recurrent retinal detachment and 7 eyes (35%) complicated with choroidal detachment preoperatively.After surgery,the retinas were reattached in 95% eyes (19/20),including retinal reattachment after first operation in 18 eyes (90%) and after second surgery in 1 eye (5%).A localized retinal detachment was still existed after a second surgery in the other 1 eye.The mean LogMAR vision improved from preoperative 2.77±0.81 to postoperative 1.22±0.46 (P=0.000).All the phakic eyes developed different degrees of sub-capsular cataract.Long-term ocular hypertension was found in 2 eyes after surgery. Conclusions The combination of vitrectomy and heavy silicone oil endotamponade is a safe and effective approach to retinal detachment with macular hole in high myopic patients. This procedure may improve vision and offers comfortable position after surgery for the patients. Key words: Retinal detachment; High myopia; Densiron 68; Vitrectomy; Macular hole

Anatomical and visual outcomes in high myopic macular hole (HM-MH) without retinal detachment: a review

To review postoperative anatomical and functional outcomes in high myopic macular hole (HM-MH) without retinal detachment. In the PubMed database, published articles on myopic macular hole surgery from 2000 to 2013 (present days) were reviewed. Inclusion criteria were high myopia and macular hole (MH). Series with posterior retinal detachment secondary to MH and myopic foveoschisis (MFS) without MH were excluded. Main outcomes included MH closure rate, resolution of the foveoschisis, if present, and postoperative visual acuity. Optical coherence tomography (OCT) features and postoperative evolution were also evaluated when reported. A total of 131 articles were initially found. After having applied the exclusion criteria, 15 articles were reviewed. Four were focused on HM-MH with concomitant foveoschisis (Schisis Group), and ten included only HM-MH without FS case series (Flat Group). Only one comparative study between these two groups was found. Surgical techniques were observed to be similar for both groups in most series, including vitrectomy with or without internal limiting membrane (ILM) removal, and gas or silicone oil tamponade. However, in one retrospective study, macular buckling was applied together with pars plana vitrectomy in cases of HM-MH with foveoschisis. When available, preoperative and postoperative OCT provided a useful evaluation of the status of the macula. Different prognosis were observed in the two groups in cases of vitreous surgery: anatomical success rate and functional outcomes for HM-MH with foveoschisis were markedly poorer than that for cases of HM-MH without foveoschisis, and multiple procedures might be required. By the contrast, better results seemed to be achieved using the posterior buckle technique for patients with HM-MH and concomitant foveoschisis. Moreover, when compared, final anatomical and functional outcomes seem to be less satisfactory than in emmetropic eyes. Postoperative non-closure or reopening of the macular hole is more common in eyes with HM-MH and concomitant foveoschisis, and possible retinal detachment may occur in these patients. Despite similar surgical procedures, anatomical and functional results after vitreous surgery in cases of HM-MH may be very different from series to series. The prognosis is generally better in cases involving only HM-MH without foveoschisis than in cases with MH and associated foveoschisis. Persistent MHs are more frequent in eyes with concomitant retinoschisis, and this seems to represent a possible risk factor for late retinal detachment in the case of unsuccessful vitreous surgery. However, although vitrectomy can lead to anatomical and visual improvements, an higher axial length > 30mm and the presence of a posterior staphyloma seem to remain the two most important risk factors for poor visual outcomes. For these reasons, a different surgical approach, including macular buckling, might be considered in casse of HM-MH and concomitant myopic foveoschisis, in order to counteract the traction exerted by the posterior staphyloma.

Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study

To evaluate postoperative outcomes after macular buckling together with pars plana vitrectomy (PPV) in previously untreated and recurrent retinal detachment secondary to macular hole (MH) in highly myopic eyes. In a retrospective cohort study, 42 eyes of 42 high myopic patients with retinal detachment due to MH were evaluated. Patients were divided into previously untreated retinal detachment (group 1, 21 eyes) and recurrent retinal detachment (group 2, 21 eyes). Macular buckling and PPV were performed in all patients. Main outcomes included retinal reattachment rate, macular hole closure rate and best-corrected visual acuity (BCVA) at 3, 6, and 12 months. Optical coherence tomography (OCT) was performed both pre- and postoperatively in all patients to assess the anatomical status of the macula. Primary retinal reattachment rate in group 1 was 95% (20/21), which increased to 100% (21/21) after a second surgery. MH closure was achieved in 81% of patients (17/21) after one surgery. The mean preoperative BCVA (logarithm of the minimum angle of resolution, LogMAR) improved from 1.32 (95% CI 1.19;1.44) to 0.76 (95% CI 0.56;0.96) 12 months postoperatively. In all except one case, gas tamponade was preferred. Primary reattachment and MH closure rate in group 2 were 90.5% (19/21) and 57% (12/21) respectively, and did not improve after a second surgery. Preoperative BCVA (LogMAR) was 1.39 (95% CI 1.29;1.49) and improved to 0.95 (95% CI 0.75;1.15) at 12 months. Silicone oil tamponade was used in seven of 21 patients, and finally was removed in five of them. Macular buckling combined with PPV should be considered a preferred surgical approach both in primary and recurrent retinal detachment secondary to MH in high myopic eyes. Nevertheless, visual outcomes seem to be better when macular buckling is chosen as first-line treatment.

Efficacy assessment of optical coherence tomography in high myopia macular hole after silicone oil tamponade

Efficacy assessment of optical coherence tomography in high myopia macular hole after silicone oil tamponade

Evaluation of the recurrence risk of macular hole in the high myopia after removing silicone oil by spectral domain optical coherence tomography

Background Macular hole in high myopia has been paid tremendous attention in clinical research due to its high recurrence rate and unpredictable prognosis.Spectral domain optical coherence tomography (SD-OCT) is considered to be of a good evaluating value for macular hole,yet its application is compromised in patient with high myopia.High myopia might lead to retinal detachment which consequently prevents an accurate OCT.Therefore,it is important to assess the effectiveness of OCT on prognosis in these patients after surgical restoration of the detached retina.Objective The aim of this study was to evaluate the risk of reopening of a macular hole in highly myopic patient after removing silicone oil by SD-OCT.Methods A case-observational study was designed.Twenty-five highly myopic patients with monocular macular holes who underwent vitrectomy combined with internal limiting membrane peeling and silicone oil tamponade were included in this study.Four patients were male and 21 patients were female,with the average age (61.4±9.0) years old and diopter (-14.14 ±6.86)D.Regular ocular examination,axial length measurement,fundus photography and OCT were performed at the day before removing silicone oil and every month till the 6 months after operation.Retinal thickness,macular height index (MHI) and choroidal thickness were measured by OCT.Written informed consent was obtained from each patient.Results All 25 patients finished the follow-up of 6 months.Macular holes remained closure 6 months after operation in 19 patients (76％) and reopened in 6 patients macular holes were in 1-5 months (24％),with a mean time at (3.3± 1.4) months.The average foveal retinal thickness,MHI and the choroidal thickness at the middle of the macular hole were (216.5±95.6) μm,0.30 ± 0.09 and (122.9 ± 20.5) μm in the closed group,respectively,and those in the unclosed group were (113.5±28.7) μm,0.58±0.27 and (96.8±22.9) μm,with significant differences between the two groups (t=2.577,-4.143,2.669,P ＜ 0.05).The percentage of macular hole closure was 85.7％ in the MHI＜0.5 group and 25.0％ in the MHI ≥ 0.5 group,showing a significant difference (P =0.031).The base diameter in the unclosed hole group was significantly larger than that in the closed hole group (1070.2±393.6 μm versus 533.3±277.7 μm) (t =-3.700,P =0.001).Conclusions The measurements of the retinal thickness,MHI and the choroidal thickness at the central area of the macular hole are helpful for the evaluation of reopening risk of macular hole after removing silicone oil. Key words: High myopia; Macular hole; Silicone tamponade; Prognosis; Tomography/optical coherence tomography image

Efficacy of Inverted Internal Limiting Membrane Flap Technique for the Treatment of Macular Hole in High Myopia

To determine the effect of pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap technique for macular hole with or without retinal detachment in highly myopic eyes. Retrospective, interventional case series. Ten eyes of 10 patients with macular hole with (4 eyes) or without (6 eyes) retinal detachment in high myopia (axial length more than 26.5mm) were treated by PPV with inverted ILM flap technique. Macular hole closure was observed in 8 eyes (80%) following the initial surgery (in 5 eyes without retinal detachment and in 3 eyes with retinal detachment). In 4 eyes with retinal detachment caused by macular hole, retinas of 3 eyes were reattached by the initial surgery. Postoperative best-corrected visual acuity improved by more than 2 lines in 5 eyes (50%), was unchanged in 4 eyes (40%), and worsened by more than 2 lines in 1 eye (10%). Inverted ILM flap technique might contribute to a high closure rate of macular hole and be a preferable adjuvant to the treatment of macular hole in high myopia with or without retinal detachment.

VITRECTOMY OUTCOMES IN EYES WITH HIGH MYOPIC MACULAR HOLE WITHOUT RETINAL DETACHMENT

The purpose of this study is to evaluate the vitrectomy outcomes for high myopic patients with macular hole (MH) without retinal detachment and to compare these outcomes with those of control patients with idiopathic MH undergoing similar surgeries by the same surgeon. The study was designed as a matched, case-control, retrospective chart review. We performed a retrospective chart review of consecutive cases that underwent vitrectomy for MH without retinal detachment from 2000 through 2008. Twenty-four eyes of 24 patients were selected to participate in this study. They were divided into 2 groups: 12 study eyes with high myopic MH without retinal detachment and 12 control eyes with idiopathic MH. The main outcomes were preoperative, postoperative best-corrected visual acuity (BCVA), MH closure rates, and complications in both groups. There was a closure rate of 100% in both the study and control groups, and no cases of reopening were reported during the follow-up visits. After surgery, the mean BCVA of the study group remained stable. There was no significant improvement of mean BCVA after surgery (P = 0.35) in the study group. The mean BCVA of the control group improved significantly (P = 0.00) after surgery. The mean postoperative BCVA in the study group was significantly lower than that in the control group in a comparison using the Student's t-test (P = 0.01). In the study group, the BCVA improved or remained stable after surgery in 8 eyes (67%). In the control group, the BCVA of all eyes improved or remained stable. The proportion of eyes with BCVA improvement after surgery was significantly higher in the study group than in the control group (P = 0.03). Disappearance of the outer nuclear layer and photoreceptor layer in the foveola and thinning of the foveola was showed in the postoperative optical coherence tomography images of four eyes in the study group while in none of the eyes in the control group. In summary, vitrectomy results in satisfactory anatomical improvement in patients with high myopic MH without retinal detachment. However, the visual acuity outcomes of the high myopic MH patients without retinal detachment were poorer than those for patients with idiopathic MHs.

The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia

The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia

Efficacy of Primary Silicone Oil Tamponade for the Treatment of Retinal Detachment Caused by Macular Hole in High Myopia

To determine the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and primary silicone oil tamponade without any postoperative position restrictions for retinal detachment (RD) caused by macular hole in high myopia. Retrospective, interventional case series. Twenty-four eyes of 24 patients with RD caused by macular hole in high myopia (axial length more than 27.0 mm) were treated by PPV with ILM peeling and primary silicone oil tamponade. No position restrictions were issued to patients postoperatively. The retina reattached in 22 eyes (92%) following the initial surgery. The final retinal reattachment rate was 100% after a second surgery of macular buckling for the 2 eyes with initial failure. For eyes with initial successful reattachment, the mean best-corrected visual acuity (BCVA) was significantly improved from 1.8 ± 0.5 logMAR units before surgery to 1.2 ± 0.4 (P < .001, paired t test). No clinical factors were significantly associated with improvement of BCVA or macular hole closure using multivariate analysis. For the treatment of RD caused by macular hole, PPV with ILM peeling and primary silicone oil tamponade showed a high retinal reattachment rate without any postoperative position restrictions. It also improved postoperative BCVA significantly. This may be a preferable method for the treatment of RD caused by macular hole in high myopia.

The Role of Diagnostic Imaging Techniques in the Management of Retinal Detachment Due to Macular Hole in High Myopia

After preoperative assessment revealed anomalous posterior vitreous detachment, a 75-year-old woman affected with retinal detachment due to macular hole was scheduled to undergo the posterior episcleral buckling procedure. Preoperative microperimetry showed unstable eccentric fixation with a dense scotoma within the central 8 degrees. One month postoperatively, best-corrected visual acuity increased from 1.70 to 0.88 logarithm of the minimum angle of resolution. Ultrasonography and optical coherence tomography revealed the indentation of the posterior scleral profile due to the buckle. The retina appeared fully attached and a macular hole with flattened edges was still detectable. Microperimetry showed stable central fixation with recovery of retinal sensitivity within the central 2 degrees. Diagnostic imaging techniques guided the decision to use the posterior episcleral buckling procedure. Microperimetry was useful to explain vision improvement despite residual macular hole.

Krypton yellow laser for the treatment of macular hole in high myopia without retinal detachment

To evaluate the prophylactic effect of krypton yellow laser for the treatment of macular holes in high myopic eyes in order to reduce the risk of retinal detachment. Twenty-seven eyes of 27 patients with high myopia and macular holes were randomly assigned to two groups. Fifteen patients (group A, 15 eyes) were subject to laser photocoagulation around the hole margin along with an oral placebo (vitamin B1), while 12 patients (group B, 12 eyes) were only given the oral placebo (vitamin B1). The incident rate of retinal detachment due to macular hole and the mean best-corrected visual acuity of the two groups before and after treatment were measured. The data were statistically tested by X2 test and Student's t test. The incident rates of retina1 detachment in group A and group B were 20%(3/15) and 58.3%(7/12), respectively (X2=4.201, P0.05). The mean BCVA of group B on the initial examination was 24/200, while the mean BCVA at the final follow-up was 30/200 (P>0.05). No significant difference in initial visual acuity (P>0.05) or final visual acuity (P>0.05) was found between the two groups. Krypton yellow laser photocoagulation could reduce the incidence of retinal detachment due to a macular hole in high myopia with acceptable functional results in this study.

The internal limiting membrane peeling with brilliant blue G staining for retinal detachment due to macular hole in high myopia

Internal limiting membrane (ILM) peeling without dye is technically difficult in retinal detachment due to macular hole in high myopia (MHRD) with chorioretinal atrophy because of poor visualisation of ILM....

Factors associated with foveoschisis and foveal detachment without macular hole in high myopia

To investigate the associated factors of foveoschisis and foveal detachment without macular hole in highly myopic eyes. A cross-sectional study of 124 eyes of 68 highly myopic patients was performed. The patients underwent complete ocular examination, fundus photography, and optical coherence tomography (OCT). Of the 124 eyes, 10 (8%, 10/124) had foveoschisis or foveal detachment without a macular hole on OCT examination. On the basis of univariate analysis, six variables were associated with the pathologic changes, including age over 40 years (P=0.018), spherical equivalent over 10 D (P=0.042), axial length over 31 mm (P=0.001), macular chorioretinal atrophy (P=0.00003), posterior staphyloma (P=0.0003), and vitreoretinal interface factors, including epiretinal membrane, posterior vitreoschisis, and vitreomacular traction (P=0.00002). In the multivariate analysis, three factors were independently associated with foveoschisis and foveal detachment without macular hole in high myopia: axial length, macular chorioretinal atrophy, and vitreoretinal interface factors. Foveoschisis and foveal detachment without macular hole are sight-threatening disorders in highly myopic eyes. Axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated with these pathological conditions. Thus, both intraocular and outer ocular wall factors play important roles and merit further study.

Retinal detachment associated with macular hole in high myopia: Using the vitreous anatomy to optimize the surgical approach

Purpose To evaluate the efficacy of different surgical strategies on the postoperative outcomes of retinal detachments (RDs) associated with macular holes (MHs) in high myopia. Design Prospective, noncomparative case series. Participants The study included 120 phakic, highly myopic eyes (mean degree of myopia, −22.2±4.80 diopters) with RDs and MHs that underwent surgical repair. The patients were divided into 2 groups. Group 1 consisted of 60 eyes with a posterior vitreous detachment (PVD). Mean preoperative visual acuity (VA) was 20/200±20/500. Group 2 consisted of 60 eyes with posterior vitreous schisis (PVS). The mean preoperative VA was 20/152±20/333. The minimum follow-up was 6 months. Intervention The surgical approach was chosen on the basis of the clinical characteristics. Twenty-five eyes of group 1 underwent pneumoretinopexy (group 1A), whereas 35 eyes of group 1 were repaired with vitrectomy (group 1B). Forty-nine eyes of group 2 underwent pars plana vitrectomy (group 2A), whereas 11 eyes of group 2 underwent scleral buckling of the macula (group 2B). Main outcome measures Anatomic attachment of the retina and VA. Results Retinal reattachment at 6 months was achieved in 23 of 25 (92%) eyes of group 1A, 31 of 35 (88.5%) eyes of group 1B, 45 of 49 (91.8%) eyes of group 2A, and 8 of 11 (72.7%) eyes of group 2B. A significant ( P<0.01) improvement of postoperative VA with respect to the preoperative values was observed in all groups. The greatest percentage improvement in postoperative VA was observed in groups 1A and 1B eyes. Conclusions Different surgical approaches can be used to repair myopic RD associated with an MH. The choice between different surgical techniques may depend on vitreoretinal relationships, the extent of chorioretinal atrophic areas, and presence of posterior staphyloma. In our study, eyes with a PVD had significantly better visual outcomes than detachments in eyes with PVS.

Surgical Treatment of Retinal Detachment due to Macular Hole in High Myopia

The use of vitrectomy combined with the adjunct of 18% C3F8 or silicone oil is a safe and effective method in treating retinal detachment due to macular hole in high myopia. Preoperative careful examination of ocular fundus, appropria te surgical design, and better surgical expertise are basic factors in treating this disease.

Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia

PurposeTo report the prevalence of foveal retinal detachment without macular hole in a large number of highly myopic eyes using optical coherence tomography (OCT), and to clarify the demographic characteristics associated with foveal retinal detachment in these eyes. DesignA consecutive, prospective, observational case series. MethodsIn 134 eyes of 78 consecutive patients with high myopia (refractive error of –8 diopters or more), we performed complete ophthalmic examinations and studied cross-sectional images of the macula with OCT. The patients were divided into two groups according to the presence (group 1, n = 78 eyes of 45 patients) or absence (group 2, n = 56 eyes of 33 patients) of posterior staphyloma. Slit-lamp examination with a Goldmann three-mirror lens indicated that none of the eyes had a macular hole. ResultsIn seven of 78 eyes (9.0%) with posterior staphyloma (group 1), OCT revealed foveal retinal detachment. Two of the seven eyes had foveal retinoschisis. Optical coherence tomography revealed no retinal detachment or retinoschisis in any eye without posterior staphyloma (group 2). Visual acuity of the seven eyes with foveal retinal detachment ranged from 20/40 to 20/200. Two of the seven eyes had visual acuity 20/50 or better. No patients complained of recent, progressive visual impairment. All seven eyes with foveal retinal detachment had severe myopic fundus changes (focal chorioretinal atrophy or bare sclera). ConclusionsIn highly myopic eyes with posterior staphyloma, the prevalence of foveal retinal detachment without macular hole was 9.0%. In eyes with this type of retinal detachment, visual acuity varies and foveal retinal detachment tends to be missed on routine examination. Periodic examination using OCT is recommended for highly myopic eyes with severe myopic degenerative changes and posterior staphyloma.