Myopic Macular Hole Research Articles

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.

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.

Vitreous tamponades in highly myopic eyes.

The use of endotamponade agents has gained a major role in the management of macular complications of high myopia. Myopic foveoschisis and macular hole are the main macular complication of pathologic myopia, this growing condition that is a main cause of visual loss, especially in patients at a younger age. We discuss the physical properties and advantages and disadvantages of the main ocular tamponade agents used in the treatment of these diseases.

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.

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.

Prognostic Factor Analysis of Vitrectomy for Retinal Detachment Associated with Myopic Macular Holes

To describe the anatomic and functional outcomes in a cohort of subjects undergoing vitrectomy for retinal detachment (RD) resulting from myopic macular hole (MH) and to analyze the prognostic and surgical factors predicting retinal reattachment and MH closure. Retrospective case series. All patients who underwent vitrectomy for RD resulting from myopic MH between 2000 and 2009 at our center. Case records were reviewed at 6 months after surgery. Retinal reattachment and complete anatomic success, defined as retinal reattachment with MH closure, were assessed. Multivariate logistic regression models, including age, gender, duration of symptoms, spherical equivalent refraction (SE), internal limiting membrane peeling, tamponade choice, and concurrent scleral buckling, were constructed to assess associations with covariates. Retinal reattachment and complete anatomic success (retinal reattachment with MH closure). In total, 114 subjects were analyzed. Most were women (n= 79 [69.3%]), and the mean age was 57.5±13.3 years. The mean SE was-9.88±6.37 diopters. At 6 months, 98 subjects (86.0%) demonstrated retinal reattachment, of whom 93 subjects required only 1 operation. Complete anatomic success was achieved in 61 subjects (53.5%), of whom 55 needed only 1 operation. Subjects with retinal reattachment had better best-corrected visual acuity (BCVA; mean BCVA, 1.22±0.81 logarithm of the minimum angle of resolution [logMAR] units) than those without (mean BCVA, 1.98±1.26 logMAR units; P < 0.001), and subjects with complete anatomic success had better BCVA (mean BCVA, 1.05±0.87 logMAR units) than those without (mean BCVA, 1.62±0.87 logMAR units; P < 0.001). In multivariate analyses, increasing age and the use of perfluoropropane (C3F8) tamponade were predictive of anatomic success (per 1-year increase: odds ratio [OR], 1.049; 95% confidence interval [CI], 1.002-1.099; P= 0.04; and for tamponade: OR, 10.71; 95% CI, 1.08-106.29; P= 0.04). Vitrectomy is effective in the repair of RD resulting from MH in myopic eyes, with retinal reattachment achieved more frequently than MH closure. Retinal reattachment and MH closure are important for improving visual outcomes. Greater age at presentation and use of C3F8 are associated with a greater likelihood of anatomic success.

Myopic macular hole-associated retinal detachment with proliferative vitreoretinopathy

PurposeThe objective of this study was to report the clinical characteristics and surgical results of patients suffering from retinal detachment, which was induced by a myopic macular hole and complicated by proliferative vitreoretinopathy, but without previous vitreoretinal surgery. MethodsInterventional case series of 22 eyes in 20 patients with excessive myopia and macular hole-associated retinal detachment complicated with proliferative vitreoretinopathy were scrutinized retrospectively. All eyes had undergone par plana vitrectomy, including peeling of the epiretinal membrane, internal limiting membrane around the macular hole, and silicone oil or perfluoropropane (C3F8) retinal tamponade. An encircling buckle was also inserted in some of the eyes. Eyes with previous vitreoretinal surgery were excluded from this review. ResultsThe average age of patients was 68.3 ± 7.17 years, average duration of symptoms prior to seeing an ophthalmologist 8.36 ± 4.14 months, and average axial length 30.01 ± 1.81 mm. Nine of the 20 patients had bilateral retinal detachment. The average number of operations performed was 1.36 ± 0.58. The success rate of the initial surgery was 63.3%, which improved to 90.9% in subsequent procedures. ConclusionA macular hole with proliferative vitreoretinopathy is associated with retinal detachment for a long duration. Retinal reattachment and improved visual acuity could be achieved in most eyes after a surgical intervention.

What are we doing in difficult cases (Not closed, Myopic, Large)?

AbstractMacular hole surgery results are generally very good. The closing rate is almost 92%. Patient can gain significant vision. There is though a group of difficult cases. The very large, the myopic macular holes and the redo cases. Traditional and novel techniques will be proposed in order to get the optimal anatomical and functional result.

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

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.

Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis

To assess the role of Spectral Domain Optical Coherence Tomography (SD-OCT) measurements as prognostic factors in myopic macular hole (MMH) surgery. In a retrospective cohort study, we evaluated 42 eyes of 42 patients (Spherical equivalent > -6.00 D) who underwent pars plana vitrectomy with internal limiting membrane peeling for MMH without foveoschisis. Statistical analysis was performed to correlate postoperative best corrected visual acuity (BCVA) with preoperative BCVA, age, degree of myopia and seven preoperative OCT measurements: macular hole (MH) base, MH minimum diameter, MH height, Hole Form Factor (HFF), Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI). Primary and final anatomical success rate were 83.3% (35/42) and 90.5% (38/42), respectively. Four patients deferred reoperation and three underwent a second surgical approach to achieve MH closure. A posterior staphyloma was observed in 27 of 42 patients, and in three of them the MH was located in the apex of the staphyloma. Two of these three cases showed an open MH after the first surgery. Postoperative visual acuity improved in 22/42 (52.4%) patients, worsened in 7/42 (16.7%) and remained unchanged in 13/42 (30.9%). Only MH minimum diameter (P = 0.03) and HFF (P = 0.02) correlated significantly with postoperative BCVA. Minimum diameter and HFF are strongly correlated with postoperative visual outcomes in cases of MMH. Since analyzing MH configuration seems to improve the anatomical success rate after vitreous surgery in highly myopic patients, these parameters should be preoperatively evaluated by SD-OCT.

Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole.

To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole. Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post-EMB. The duration of follow-up time after removalof silicone oil was more than 3 months. Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08. Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome.

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

Efficacy of C3F8 versus silicone oil intraocular tamponade for severe highly myopic macular hole retinal detachment

Objective To compare the outcome of C3F8 versus silicone oil intraocular tamponade after pars plana vitrectomy (PPV) for the treatment of highly myopic macular hole retinal detachment (MHRD).Methods Thirty-two highly myopic MHRD patients (32 eyes) with extreme long axial lengths (≥ 29.0 mm), severe retina pigment epithelium (RPE) and chorioretinal atrophy,and posterior staphyloma who underwent PPV,were enrolled in this study.The patients were divided into two groups according to different intraocular tamponade agents:C3F8 (group A,15 eyes) and silicone oil (group B,17eyes).The patients with retinal re-detachment after surgery received PPV again.The differences of sex (P =1.000),age (t=0.444,P=0.660),best-corrected visual acuity (t=0.084,P=0.934),diopter (t=0.449,P=0.978),lens state (P=1.000),time of the symptoms (t=0.375,P=0.710) and degree of retinal detachment (x2 =0.014,P=0.907) between group A and B were not statistically significant.The anatomic reattachment of the retina,macular hole closure,and vision acuity were observed at one week,one,three,six and 12 months after surgery.Results The rates of retinal reattachment and macular hole closure were 60.00％ and 13.33 ％ in group A,82.35％ and 29.41％ in group B in the first time of surgery.There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.243,0.402).The rates of retinal reattachment and macular hole closure were 86.67％ and 20.00％ in group A,94.12％ and 29.41％ in group B in the second time of surgery.There was no difference in rates of retinal reattachment and macular hole closure between two groups (P=0.589,0.691).Twelve months after surgery,the vision acuity improved in five eyes,unchanged in seven eyes,and decreased in three eyes in group A; the vision acuity improved in seven eyes,unchanged in eight eyes,and decreased in two eyes in group B.The differences of vision result was not statistically significant between two groups (x2 =0.209,P=0.647).Conclusion The rates of retinal reattachment and macular hole closure with silicone oil tamponade was higher than that with C3F8 tamponade in eyes with highly myopic MHRD,but the differences are not statistically significant. Key words: Myopia, degenerative/surgery; Retinal detachment/surgery; Retinal perforations/surgery; Vitrectomy; Noble gases/therapeutic use; Silicone oils/therapeutic use

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

TREATMENT OF RETINAL DETACHMENT SECONDARY TO MACULAR HOLE IN HIGH MYOPIA

To evaluate the rates of retinal reattachment and the closure of myopic macular hole because of posterior pole retinal detachment after treatment with pars plana vitrectomy and subsequent dissection of the inner limiting membrane. Prospective noncomparative study of 27 eyes from 27 phakic patients diagnosed with posterior pole retinal detachment as a result of myopic macular hole. All underwent pars plana vitrectomy with dissection of the inner limiting membrane and intravitreal silicone oil tamponade performed by the same surgeon. The main variables assessed were visual acuity, retinal reattachment, and macular hole closure determined by optical coherence tomography. Of the 27 eyes, 16 (59.3%) were right eyes and 11 (40.7%) were left eyes. Mean age was 50.5 years. Myopia ranged from -9 diopters (D) to -27 diopters (mean, -18 diopters), and axial length ranged from 28.5 mm to 35.6 mm (mean, 32.05 mm). After a mean postoperative period of 12 months, retinal reattachment was found in 85.1% of the patients and anatomical closure of the macular hole in 51.9%. This technique offers good rates of retinal reattachment and macular hole closure, although seldom increases the final visual acuity. It showed limited effectiveness in eyes with an axial length >30 mm.

MACULAR BUCKLING FOR MYOPIC MACULAR HOLE RETINAL DETACHMENT

To evaluate the efficacy and safety of a new technique of macular buckling in the treatment of myopic macular hole retinal detachment. Twenty-six consecutive cases of myopic macular hole retinal detachment were included in the study. For 20 cases, the macular buckling was the primary procedure. The other six cases were recurrent after vitrectomy and silicone oil tamponade. The technique is described in detail. Retinal attachment occurred in all cases with improvement of vision. The postoperative vision ranged from counting fingers to 6/36 depending on the degree of atrophy of the retinal pigment epithelium in the background. Only one case developed submacular hemorrhage with deterioration of vision to counting fingers close to the eye. Other complications were recorded. The described technique is remarkably accurate and does not require any specially designed implants. It is highly recommended for cases of myopic macular hole retinal detachment with atrophic background and deep posterior staphyloma and for recurrent cases after vitrectomy with or without silicone oil.

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.

Surgery for Myopic Macular Hole Without Retinal Detachment

The purpose of this paper is to review the indications, surgical technique and surgical outcome of myopic macular holes (MHs). In myopic MH, the use of optical coherence tomography has been very useful both in the diagnosis and follow-up after surgery due to the difficulty in biomicroscopic diagnosis in high myopes. Myopic MH surgery is more difficult than idiopathic MH surgery due to the increased axial length, retinal pigment epithelium and choroidal atrophy, and thinner retina making internal limiting membrane and posterior hyaloid staining more important. Myopic MH vitreoretinal surgery achieves comparable anatomical success rates when compared with idiopathic MHs except in cases with posterior staphyloma and axial lengths equal to or over 30 mm where a macular buckle may be needed. The closure of myopic MH decreases the risk of retinal detachment secondary to MH.

Two-step surgery for retinal detachment caused by myopic macular hole

PurposeTo report the results of a two-step operation for treating retinal detachments caused by macular holes in high-myopic patients.MethodsIn the first part of the operation, pars plana vitrectomy, air–fluid exchange, and silicone oil injection were performed. At 4–6 months after the first operation, the second part of the operation was performed. This involved silicone oil removal and internal limiting membrane peeling under the aid of triamcinolone acetonide with or without gas tamponade.ResultsFour eyes (four patients) underwent surgery with this technique. All retinas were attached at the time of the second operation, when internal limiting membrane peeling could be performed easily and safely. The retina remained attached in all four eyes (100%) during 24–32 months of follow-up after the second operation.ConclusionFavorable surgical results were obtained with the two-step operation in the treatment of retinal detachments resulting from myopic macular holes.