Myopic Macular Hole Retinal Detachment Research Articles

Temporal inverted internal limiting membrane flap technique for myopic macular hole retinal detachment reconstruction.

To examine the effects of the temporal inverted internal limiting membrane (ILM) flap technique for foveal reconstruction in patients with highly myopic macular hole-associated retinal detachment (MHRD). A retrospective case series analysis of four patients (four eyes) with MHRD was conducted. The foveal optical coherence tomography changes following treatment using the temporal inverted ILM flap technique were evaluated. In Patient 1, the ILM bridged the macular hole and residual subretinal fluid on postoperative day 6, and complete retinal reattachment was achieved at 19 months. Patient 2 exhibited reduced retinal detachment, with visible ILM inversion and macular hole closure after 14 days. In Patient 3, macular hole closure and fovea formation had occurred by day 25, and the ILM flap was visible. At 2 months, the outer collagenous layer connection in the central fovea and recovery of the external limiting membrane and ellipsoid zone were observed. Patient 4 had a "white hole" MHRD, with macular hole closure achieved on postoperative day 20, albeit with a suboptimal foveal shape. The temporal inverted ILM flap technique in conjunction with vitrectomy facilitates foveal reconstruction in patients with successful treatment of MHRD, and this reconstruction process can be observed by optical coherence tomography.

Clinical observation of vitrectomy combined with endolaser photocoagulation at the edge of posterior scleral staphyloma for macular hole retinal detachment in high myopia.

To observe the clinical effect of pars plana vitrectomy (PPV) and silicone oil filling surgery combined with intraoperative posterior scleral staphyloma (PS) marginal retinal photocoagulation in the treatment of high myopic macular hole retinal detachment (MHRD) with PS. This was a retrospective clinical study. From May 2017 to March 2020, 62 MHRD patients with PS (62 eyes) were enrolled in the study. Patients were divided into 23G PPV combined with PS marginal retina intraoperative photocoagulation group (combined group) and conventional surgery group (conventional group), with 31 eyes in each. Triamcinolone acetonide and indocyanine green were used to remove the epiretinal membrane and the posterior macular inner limiting membrane (ILM). In the combined group, 2 to 3 rows of retinal photocoagulation were performed on the edge of the PS. The patients were followed up for an average of 8.34±3.21mo. The first retinal reattachment rate, macular hole closure rate, Duration of silicone oil tamponade, best corrected visual acuity (BCVA) and average number of operations were observed and compared between the two groups. The first retinal reattachment rates of the eyes in the combined group and the conventional group were 96.7% (29/31) and 67.7% (21/31), respectively (χ2 =6.613, P=0.010). The macular hole closure rates in the combined group and the conventional group were 74.2% (23/31) and 67.7% (21/31), respectively (χ2 =0.128, P=0.721). The Duration of silicone oil tamponade of the patients in the combined group was lower than that of the routine group (t=-41.962, P≤0.001). Postoperative logMAR BCVA values of patients in the combined group and the conventional group were 1.27±0.12 and 1.26±0.11, compared with the logMAR BCVA before surgery, each group was improved (t=19.947, t=-19.517, P≤0.001, P≤0.001). There was no significant difference in the logMAR BCVA between the eyes of the two groups (t=-0.394, P=0.695). The average numbers of operations on the eyes in the conventional group and the combined group were 2.39±0.62 and 2.06±0.25 times, the combined group had fewer operations on average (t=-2.705, P=0.009). Intraoperative PPV treatment of MHRD with PS combined with PS marginal endolaser photocoagulation can effectively increase the rate of retinal reattachment after the first operation, reduce the number of repeated operations, and reduce the postoperative duration of silicone oil tamponade.

Modified perfluorocarbon liquid/internal limiting membrane interface staining in myopic macular hole retinal detachment.

To demonstrate a modified technique of perfluorocarbon liquid (PFCL)/internal limiting membrane (ILM) interface staining in patients affected by macular hole retinal detachment (MHRD) in the setting of high myopia. Two-surgeon retrospective case series and review of surgical videos with step-by-step technique analysis. Our modified technique was proficiently employed to treat 9 highly myopic patients affected by MHRD. Successful staining and peeling of the ILM with the creation of an inverted flap was achieved in all cases. A limited number of dye injections required to stain the ILM was noted. No subretinal dye migration or other intra- and postoperative complications were recorded. Modified PFCL/ILM interface staining is a surgically efficient technique potentially reducing the risk of iatrogenic damage, including the toxicity of vital dyes to the retinal pigment epithelium (RPE) in myopic MHRD.

The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis.

Purpose: To investigate the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique for macular hole retinal detachment (MHRD) in high myopia.Methods: This was a retrospective interventional study on 45 highly myopic eyes with MHRD after ILM peeling (n = 24, peeling group) or the inverted ILM flap technique (n = 21, inverted group). The inverted group was consisted of autologous blood (AB) subgroup (n = 10) and perfluorocarbon liquid (PFCL) subgroup (n = 11). MH closure, best-corrected visual acuity (BCVA), foveal microstructures, and excessive gliosis were analyzed during a follow-up of over 12 months.Results: The inverted group achieved a higher MH closure rate (95.24%) than the peeling group (41.67%; p < 0.001). No significant difference was found in postoperative BCVA between the two groups (p = 0.98) or between the closed MH with or without excessive gliosis (p = 0.60). Excessive gliosis was identified in 9 eyes in the inverted group, and there was no difference in the incidence of excessive gliosis between the AB subgroup (4 in 10 eyes, 40%) and the PFCL subgroup (5 in 11 eyes, 45.45%) (p > 0.999).Conclusion: The inverted ILM flap technique was effective in MH closure but had no advantage in postoperative BCVA and microstructural restoration. Excessive gliosis was only detected in the inverted group but did not affect the postoperative BCVA. Additionally, the incidence of excessive gliosis was not affected by adjuvants.

Exhibiting Residual Subretinal Fluid after High Myopic Macular Hole Retinal Detachment Surgery

Purpose: To report a case of poor visual prognosis complicated by residual subretinal fluid after use of the internal limiting membrane flap technique to treat macular hole retinal detachment in a patient with high myopia.Case summary: A 55-year-old male stated that he had experienced a transparent circle in the central visual field of the right eye for 1 month. His best-corrected visual acuity (BCVA) was 0.32 and the axial length of the right eye was 32.57 mm. Fundus examination revealed a macular hole with retinal detachment localized to the posterior pole. We performed vitrectomy, membrane peeling, internal limiting membrane peeling with inverted internal limiting membrane flap, and silicone oil injection. On day 1 after surgery, the macular hole was closed, but subretinal fluid was noticed in the macula. At 3 months after surgery, the BCVA was 0.16 and the silicone oil was removed. At 14 months after the first surgery, the subretinal fluid was completely absorbed, but leopard-pattern pigment degeneration became prominent and the macula exhibited ellipsoid zone disruption. The BCVA decreased to 0.1.Conclusions: In patients exhibiting macular hole retinal detachment in the context of high myopia, an inverted internal limiting membrane flap may increase the macular hole closure rate but disturb subretinal fluid drainage. As persistent subretinal fluid may cause permanent retinal damage with a poor visual prognosis, the surgical method must be carefully chosen.

Risk Factors for Recurrent Myopic Macular Hole Retinal Detachment after Silicone Oil Removal in Patients with Open Flat Macular Hole

Objective: To evaluate the risks that might be associated with recurrent macular hole retinal detachment (MHRD) after silicone oil (S.O) removal in myopic patients with open flat macular hole (MH). Methods: In this retrospective series, we assessed the different factors that might be associated with recurrent MHRD after S.O removal in 48 eyes with open flat MH that underwent S.O removal after successful MHRD repair. We divided the enrolled eyes into 2 groups: group 1 included 38 eyes with flat open MH and flat retina after S.O removal, and group 2 included 10 eyes with flat open MH and recurrent MHRD after S.O removal. Results: Ten of 48 eyes (20.8%) with open flat MH developed recurrent MHRD after S.O removal. Univariate logistic regression analysis revealed that MH at the apex of PS, MH minimum diameter, hole form factor (HFF), and MH index (MHI) were significant risk factors for recurrent MHRD after S.O removal in myopic patients with open flat MH. Conclusions: If there is a “flat open” MH that is large, located at the apex of PS, or with an HHF or MHI <0.9–0.5, there is a high chance of recurrent MHRD after S.O removal.

Comparison of Internal Limiting Membrane Peeling and Flap Removal to Flap Insertion on Visual Outcomes in Highly Myopic Eyes with Macular-Hole Retinal Detachment

Introduction: To compare the morphological and visual outcomes after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and flap removal to that with flap insertion in eyes with myopic macular-hole retinal detachment (MHRD). Methods: Forty-six eyes of 45 patients with MHRD were studied. Eighteen eyes were treated by PPV with ILM peeling and flap removal and 28 eyes by flap insertion, respectively. The baseline characteristics and postoperative findings were compared between the 2 groups. Results: The average age of the cases was 70.0 ± 8.5 years. The best-corrected visual acuity (BCVA) improved, from 1.51 ± 0.14 to 1.31 ± 0.20 log_MAR units in the flap removal group, and from 1.20 ± 0.10 to 0.88 ± 0.10 log_MAR units in the flap insertion group (p = 0.049). A significantly larger number of MHs were closed in the flap insertion group (96 vs. 50% in the removed group; p < 0.001). Restoration of the ellipsoid zone (EZ) and external limiting membrane (ELM) was also better in the flap insertion group than in the flap removal group (EZ 14 vs. 6%, p = 0.003; ELM 36 vs. 6%, p < 0.001). Discussion: The technique of ILM peeling with flap insertion is more effective in closing the MH, and results in better BCVA and better restoration of the outer retinal microstructures than flap removal.

PERFLUOROCARBON LIQUID-ASSISTED INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VERSUS INTERNAL LIMITING MEMBRANE PEELING FOR HIGHLY MYOPIC MACULAR HOLE RETINAL DETACHMENT.

To compare the efficacy of a modified perfluorocarbon liquid-assisted inverted internal limiting membrane (ILM) flap technique with the standard ILM peeling for the treatment of macular hole retinal detachment in highly myopic eyes. This was a retrospective, consecutive, nonrandomized comparative study. Forty-two macular hole retinal detachment eyes of 42 patients were included into either a perfluorocarbon liquid-assisted inverted ILM flap technique group (n = 22, inverted group) or standard ILM removal group (n = 20, peeling group). Outcomes measured were macular hole closure, retinal reattachment, and best-corrected visual acuity at least 6 months after surgery. Macular hole closure was achieved in 20 eyes (90.9%) in the inverted group and in eight eyes (40%) in the peeling group (P < 0.01). Reattachment rates were 100% in the inverted group and 95% in the peeling group (P = 0.476). The mean best-corrected visual acuity improvement from baseline was 27.4 ± 19.9 Early Treatment Diabetic Retinopathy Study letters in the inverted group while the best-corrected visual acuity improvement was 13.6 ± 22.5 Early Treatment Diabetic Retinopathy Study letters in the peeling group (P = 0.044). The perfluorocarbon liquid-assisted inverted ILM flap technique was effective in sealing the macular hole, reattaching retina, and improving visual function postoperatively in highly myopic macular hole retinal detachment.

DEVELOPMENT OF MACULAR ATROPHY AFTER PARS PLANA VITRECTOMY FOR MYOPIC TRACTION MACULOPATHY AND MACULAR HOLE RETINAL DETACHMENT IN PATHOLOGIC MYOPIA.

To determine the incidence and long-term outcome of macular atrophy (MA) after pars plana vitrectomy (PPV) in pathologic myopia. Highly myopic patients who underwent PPV for myopic traction maculopathy and macular hole retinal detachment at Tokyo Medical and Dental University between 2012 and 2016 were studied. Fundus photographs and/or optical coherence tomography were examined before and after PPV at every visit. A total of 133 eyes were followed for 39 months with the mean age of 62.8 years and the mean axial length of 30.0 mm. Postoperatively, 14 eyes (10.5%) developed fovea-centered MA, observed initially as a small, isolated, whitish lesion at the center of fovea at 3.5 months after PPV. The appearance of the MA was distinctly different from the choroidal neovascularization-related MA or patchy atrophy-related MA. With time, the lesions enlarged circumferentially. In these 14 eyes, the final best-corrected visual acuity was worse than the baseline, although the difference was not significant. The occurrence of MA was significantly associated with the preoperative foveal status. The development of MA can occur in 11% of highly myopic eyes after PPV for myopic traction maculopathy and macular hole retinal detachment. This postoperative MA might be a new complication of pathologic myopia.

Utility of microscope-integrated optical coherence tomography (MIOCT) in the treatment of myopic macular hole retinal detachment

Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM).1–3 Shimada et al4 described the progressive stages of MTM from...

Long-term surgical outcomes of the inverted internal limiting membrane flap technique in highly myopic macular hole retinal detachment.

Pars plana vitrectomy (PPV) procedures are used for the surgical treatment of macular hole retinal detachment (MHRD) associated with high myopia. Re-detachment of the retina has been reported in MHRD associated with high myopia. Our aim was to evaluate the 1-year outcomes of vitrectomy, performed using an inverted internal limiting membrane (ILM) flap technique with gas tamponade, in five cases of MHRD associated with high myopia. We performed a retrospective review of medical records of five consecutive cases of highly myopic MHRD. The following postoperative data were collected: refractive error, best-corrected visual acuity, intraocular pressure, ophthalmic fundus examination findings, ocular coherence tomography at 1, 3, 6, and 12months postoperatively; duration of the follow-up period; and intra- and postoperative complications. The primary endpoint of the study was the rate of postoperative retinal reattachment and macular hole (MH) closure. Paired t-tests were conducted to evaluate postoperative changes. Mean visual acuity improved significantly (P = 0.008), with an improvement of ≥2 lines on LogMAR value gained in three of the five eyes. Retinal reattachment was maintained in all cases, with no cases of MH reopening identified over the mean follow-up period of 20.2months. No complications were identified in any eye. The inverted ILM flap technique and gas tamponade provided primary retinal reattachment and MH closure over the ≥12-month follow-up period.

A New Sutureless Illuminated Macular Buckle Designed for Myopic Macular Hole Retinal Detachment.

Purpose. To report the anatomic and visual results of a new sutureless illuminated macular buckle designed for patients with macular hole retinal detachment related to high myopia (MMHRD). Design. Prospective nonrandomized comparative interventional trial. Methods. Twenty myopic eyes of 20 patients (mean age, 51.4 years; range, 35–65 years) presenting with MMHRD with a posterior staphyloma, in whom the new buckle was used, were evaluated. The buckle used was assembled from a 5 mm wide sponge and a 7 mm wide silicone tire; it was fixed utilizing the sterile topical adhesive Histoacryl Blue (B Braun, TS1050044FP) which polymerizes in seconds upon being exposed to water-containing substances. The primary outcomes measured included aided visual acuity (BCVA) and optical coherence tomography (OCT) findings. The mean follow-up period was 6 months. Results. Postoperatively, the MH closure was identified by OCT in 8 (40%) eyes. The mean BCVA increased from 0.11 to 0.21 (p < 0.005). The axial length of the eyes included decreased from 30.5 mm preoperatively to 29.8 mm (p = 0.002) postoperatively. Conclusion. Preparation of the new sutureless macular buckle is simple and easy. Illumination of the terminal part of the buckle ensures proper placement. Histoacryl Blue is effective in fixing the buckle in its place for at least 6 months with no reported intra- or postoperative complications.

Vitrectomy and scleral imbrication in patients with myopic traction maculopathy and macular hole retinal detachment

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.

Surgical management and treatment outcomes of myopic macular hole retinal detachment

AbstractPathological myopia (PM) complicated by macular hole retinal detachment (MHRD) may lend itself to surgical correction, however severe axial elongation of the globe, the presence of a posterior staphyloma and atrophy of the RPE and choroid make these cases challenging. Whilst vitrectomy has been the mainstay of treatment, macular buckling (MB) was also developed in order to treat the posterior staphyloma. Macular hole closure rates using OCT monitoring have been reportedly low at 10‐72% and retinal reattachment rates have varied from 40‐93%. The reports of surgical outcomes of MB for MHRD are limited, but reported retinal reattachment rates are as high as 93% after primary surgery and 100% after secondary surgery. Surgical and visual outcomes appear better than those seen with PPV surgery but visual acuity improvements were modest in a long term series with a mean log MAR improvement of 1.80 to 1.00. We carried out a survey of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) to research the UK practice patterns for the management of MHRD secondary to PM. Anatomical and visual outcomes showed variable success rates. A review of the current literature and results of the BEAVRS will be presented.

EFFECT OF 360° EPISCLERAL BAND AS ADJUNCTIVE TO PARS PLANA VITRECTOMY AND SILICONE OIL TAMPONADE IN THE MANAGEMENT OF MYOPIC MACULAR HOLE RETINAL DETACHMENT

To report the effect of 360° scleral band in combination with pars plana vitrectomy (PPV) and silicone oil tamponade on the anatomical success and on the closure of macular hole (MH) in cases of myopic macular hole retinal detachment. A retrospective consecutive interventional study from medical records on patients who had pars plana vitrectomy and silicone oil. with or without 360° scleral band for the treatment of retinal detachment associated with MH. The cases were operated in the period from February 2006 to May 2012. The included cases were classified into two groups: the first group with scleral band and the second group without scleral band. The primary anatomical success and optical coherence tomography patterns of MH closure were the main outcomes. After the first procedure, the overall success rate was 90.6% (in both groups). In 9.4%, there was recurrent retinal detachment. In the first group the success rate was 89.5%, and in 10.5% there was recurrent retinal detachment. In the second group 92.5% was success and 7.5% was recurrent retinal detachment. After the second interference, the success rate was 98.4% in both groups. Closure of MH was achieved in 45.2% in both groups. In the first group, there was closure of MH in 43.5%, while in 47.8% the hole remained open flat, in 4.3% the hole closed partially and in 4.3% there was macular scar. In the second group, MH closure was achieved in 47.4%, whereas in 52.6% the hole was open flat. The use of 360° band in combination with pars plana vitrectomy and silicone oil offered no additional effect on either the anatomical success or the rate of MH closure in the management of myopic macular hole retinal detachment. Four patterns of MH were reported closed MH, partial thickness MH, open flat MH, and macular scar.

Silicone Oil Reinjection without Macular Buckling for Treatment of Recurrent Myopic Macular Hole Retinal Detachment after Silicone Oil Removal

Purpose. To evaluate the efficacy of silicone oil (S.O) reinjection without macular buckling for treatment of recurrent myopic macular hole retinal detachment (MHRD) after silicone oil removal. Methods. A retrospective consecutive interventional study from medical reports on cases of myopic MHRD. Fifty-three eyes of 51 patients underwent silicone oil removal after successful repair of MHRD were reviewed. The main outcomes were the retinal status after silicone oil removal and management of recurrent cases. Results. The rate of recurrent RD (Re RD) after silicone oil removal was 11.3% (6 out of 53 eyes). One case refused any other interference. In the remaining 5 eyes, 4 eyes (80%) could be reattached by S.O re-injection and one eye (20%) developed Re RD after S.O re-injection. Range of followup after management of recurrence was 5–53 months (mean 18.7 months). Conclusions. This case series concluded that the risk factors for recurrent RD after silicone oil removal from cases of myopic MHRD were high myopia, open flat MH, and large posterior staphyloma. Revision of vitrectomy and S.O re-injection can reattach most of recurrent cases.

SUPRA CHOROIDAL BUCKLING IN MANAGING MYOPIC VITREORETINAL INTERFACE DISORDERS

To evaluate the efficacy of supra choroidal buckling procedure using a supra choroidal catheter, as a new approach in treating myopic vitreomacular interface disorders specially in difficult cases of myopic traction maculopathy with or without macular hole retinal detachment in posterior staphyloma depending on the concept of indenting the choroid only, from a 1-year data study. A newly developed supra choroidal catheter was used to deliver stabilized, cross-linked, long-acting hyaluronic acid as a filler in the supra choroidal space in the area of the staphyloma forming a choroidal indenting effect. Before the injection, pars plana vitrectomy was performed without internal limiting membrane peeling to avoid the risk of break of the roof of foveal detachment in case of foveoschisis. This indentation was used to treat 11 patients with myopic foveoschisis and 12 patients with myopic macular hole retinal detachment, 5 of whom had failed primary repair by vitrectomy before inclusion in this trial. Clinical and optical coherence tomographic evaluations of these patients were performed over 1-year follow-up. Retinal layer restoration was achieved in all 11 eyes with myopic foveoschisis. This was gradual over a period of 2 to 6 weeks postoperatively. No recurrence over the 12-month follow-up was observed. Visual acuity improved by 1 line or more in 9 eyes (81.8%). Of the 12 eyes, 10 with macular hole detachment (83%) showed closure of the holes in association with the resolution of the detachment; 2 eyes showed resolution of the detachment and flatting of the edge of the holes but with incomplete closure on optical coherence tomography. Eight eyes (66.6%) showed improvement in visual acuity by 1 or more lines with no recurrence of retinal detachment over the 12-month follow-up period. The indentation effect was sufficient over the 12-month follow-up period. The indentation effect achieved by supra choroidal approach can be used as a method of managing myopic foveoschisis and myopic macular hole with detachment even in eyes with failed primary vitrectomy, counteracting the role of posterior staphyloma in the role of the disease. The indentation effect is sufficient for first year of follow-up.

EFFICACY OF VITRECTOMY WITH TRIAMCINOLONE ASSISTANCE VERSUS INTERNAL LIMITING MEMBRANE PEELING FOR HIGHLY MYOPIC MACULAR HOLE RETINAL DETACHMENT

To compare the outcomes of pars plana vitrectomy (PPV) with or without the adjuvant surgical procedures: triamcinolone acetonide (TA) assistance and/or internal limiting membrane (ILM) peeling for the treatment of highly myopic macular hole retinal detachment (MHRD). Case-control study. Pars plana vitrectomy combined with 2 kinds of adjuvant surgical procedures were used on 96 highly myopic eyes with MHRD. These eyes were assigned to 4 groups randomly: Group 1, non-TA-assisted PPV and without ILM peeling; Group 2, non-TA-assisted PPV with ILM peeling; Group 3, TA-assisted PPV and without ILM peeling; Group 4, TA-assisted PPV with ILM peeling. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity were measured. The rates of both retinal reattachment and macular hole closure were higher in Group 2 (84.0 and 44.0%) and Group 3 (80.8 and 46.2%) than Group 1 (73.9 and 17.4%); however, there were no differences between Group 2 and Group 3 (P > 0.05). The rates of macular hole closure were extremely low in Group 1 and also in eyes with extreme long axial lengths (≥29.0 mm), "severe" chorioretinal atrophy, and posterior staphyloma. Pars plana vitrectomy with either TA assistance or ILM peeling was effective for the treatment of highly myopic MHRD. If you peel the ILM, adding TA does not affect closure rates; and if TA is used to visualize the vitreous, ILM peeling may not be necessary in MHRD. There was a lower anatomical success rate in MHRD with extreme long axial lengths, severe chorioretinal atrophy, and posterior staphyloma.

Efficacy of internal limiting membrane peeling and silicone oil tamponade for highly myopic macular hole retinal detachment

Objective To observe the effect of pars plana vitrectomy (PPV) with epiretinal membrane peeling (ERMP) and (or) internal limiting membrane peeling (ILMP) and silicone oil tamponade for highly myopic macular hole retinal detachment (MHRD) with posterior staphyloma.Methods Eighty-five highly myopic MHRD patients (85 eyes) were enrolled in this study.All the patients were examined for corrected visual acuity (CVA),slit lamp microscope and preset lens,indirect ophthalmoscope,A/B ultrasound,optical coherence tomography (OCT) and intraocular pressure examination.The average axial length was (29.1± 1.8) mm.There were 24 eyes with diffuse choroid atrophy and 61 eyes with partial choroid atrophy.The CVA was converted into a logarithm of the minimal angle of resolution (logMAR) for statistical analysis.The average logMAR CVA was 1.93± 0.37.All the patients were treated with PPV and triamcinolone acetonide (TA) or indocyanine green (ICG) assisted ILMP and (or) ERMP and silicone oil tamponade.TA assisted ERMP was performed in 21 eyes; with ICG assisted ILMP in 56 eyes and TA assisted ILMP in eight eyes.The duration of silicone oil tamponade was (6.2± 1.6) months.CVA,retina and macular hole status and complications were observed postoperatively.Differences between preoperative and postoperative CVA were evaluated by the t test and correlation analysis.Multiple logistic regression analysis was performed to assess the influence of individual preoperative factors on the initial anatomical success.Differences in the macular hole closure rate between eyes with or without macular schisis were evaluated for statistical significance using corrected chi square.Results The mean logMAR CVA was 1.34±0.48 after surgery,which significantly improved compared to that before surgery (t=39.38,P＜0.01).The CVA after surgery was independent of axial length (r=0.142,P＞0.05),choroidatrophy(t=0.23,-0.165,P＞0.05) and macular hole closure (t=0.12,-0.005,P＞0.05).The retina reattached in 79 eyes (92.9 ％) and recurrence of retinal detachment occurred in six eyes (7.1 ％).Multiple logistic regression analysis indicated that recurrence of retinal detachment was independent of choroid detachment,proliferative vitroretinopathy,axial length,choroid atrophy and IL MP (OR=1.428,5.039,0.815,2.578,0.432; P＞0.05).Of these 85 eyes,macular hole closed in ten eyes (11.8％),macular hole did not close in 75 eyes (88.2％).There were 24 eyes (28.2％) experienced high intraocular pressure during the first 2 weeks after surgery,allof them were under control with drugs.There were 12 eyes (14.1％) presented with high intraocular pressure before the silicone oil removal,all of them were under control only by silicone oil removal.Conclusion For the treatment of MHRD with posterior staphyloma,PPV combined with ERMP and (or) IL MP and silicone oil tamponade show a high retinal reattachment rate. Key words: Myopia, degenerative/surgery; Retinal detachment/surgery; Retinal perforations/surgery; Vitrectomy; Silicone oils/therapeutic use

Efficacy of vitrectomy for moderate and extreme highly myopic macular hole retinal detachment

Objective To compare the outcome of pars plana vitrectomy (PPV) with triamcinolone (TA) assistance and internal limiting membrane (ILM) peeling for the treatment of moderate and extreme highly myopic macular hole retinal detachment (MHRD).Methods Fortyone highly myopic MHRD patients (41 eyes) who underwent PPV with TA assistance and ILM peeling were enrolled in this study.These eyes were divided into two groups according to different anatomic features:group A (24 eyes) had a consistent moderate long axial lengths (＜ 29 mm), mild retinal pigment epithelium (RPE) and chorioretinal atrophy,and posterior staphyloma (level 0-1 and depth ≤2 mm); while group B (17 eyes) had a consistent extreme long axial lengths (≥29 mm),severe RPE and chorioretinal atrophy,and posterior staphyloma (level 2 3 and depth＞2 mm).All the patients underwent C3F8 tamponade at the end of PPV.The anatomic reattachment of the retina,macular hole closure,and visual acuity were observed at 12 months after surgery.Results The rates of retinal reattachment and macular hole closure were 91.67％ and 58.33％ in group A,64.71％ and 17.65 ％ in group B in the first time of surgery.The differences of rates of retinal reattachment (P=0.049) and macular hole closure (x2 =6.787,P=0.009) between two groups were statistically significant.The rates of retinal reattachment and macular hole closure were 95.83％ and 58.33％ in group A,88.23％ and 29.53％ in group B in the second time of surgery.The difference of retinal reattachment rate between two groups was not statistically significant (P=0.560).The difference of macular hole closure rate between two groups was statistically significant (x2 =4.894,P=0.027).Twelve months after surgery,the vision acuity improved in 14 eyes,unchanged in nine eyes,and decreased in one eye in group A; the vision acuity improved in six eyes,unchanged in eight eyes,and decreased in three eyes in group B.The differences of vision result between two groups was not statistically significant (x2 =0.209,P=0.647).Conclusion After PPV with TA assistance and ILM peeling,the rates of retinal reattachment and macular hole closure in eyes with moderate highly myopic MHRD are higher than that in eyes with extreme highly myopic MHRD,but there is no difference in visual acuity. Key words: Myopia, degenerative/surgery; Retinal detachment/surgery; Retinal perforations/surgery; Vitrectomy