Retinal Detachment In High Myopia Research Articles

Development and validation of a routine blood parameters-based model for screening the occurrence of retinal detachment in high myopia in the context of PPPM.

Timely detection and treatment of retinal detachment (RD) could effectively save vision and reduce the risk of progressing visual field defects. High myopia (HM) is known to be associated with an increased risk of RD. Evidently, it should be clearly discriminated the individuals with high or low risk of RD in patients with HM. By using multi-parametric analysis, risk assessment, and other techniques, it is crucial to create cutting-edge screening programs that may be utilized to improve population eye health and develop person-specific, cost-effective preventative, and targeted therapeutic measures. Therefore, we propose a novel, routine blood parameters-based prediction model as a screening program to help distinguish who should offer detailed ophthalmic examinations for RD diagnosis, prevent visual field defect progression, and provide personalized, serial monitoring in the context of predictive, preventive, and personalized medicine (PPPM/3 PM). This population-based study included 20,870 subjects (HM = 19,284, HMRD = 1586) who underwent detailed routine blood tests and ophthalmic evaluations. HMRD cases and HM controls were matched using a nested case-control design. Then, the HMRD cases and HM controls were randomly assigned to the discovery cohort, validation cohort 1, and validation cohort 2 maintaining a 6:2:2 ratio, and other subjects were assigned to the HM validation cohort. Receiver operating characteristic curve analysis was performed to select feature indexes. Feature indexes were integrated into seven algorithm models, and an optimal model was selected based on the highest area under the curve (AUC) and accuracy. Six feature indexes were selected: lymphocyte, basophil, mean platelet volume, platelet distribution width, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Among the algorithm models, the algorithm of conditional probability (ACP) showed the best performance achieving an AUC of 0.79, a diagnostic accuracy of 0.72, a sensitivity of 0.71, and a specificity of 0.74 in the discovery cohort. A good performance of the ACP model was also observed in the validation cohort 1 (AUC = 0.81, accuracy = 0.72, sensitivity = 0.71, specificity = 0.73) and validation cohort 2 (AUC = 0.77, accuracy = 0.71, sensitivity = 0.70, specificity = 0.72). In addition, ACP model calibration was found to be good across three cohorts. In the HM validation cohort, the ACP model achieved a diagnostic accuracy of 0.81 for negative classification. We have developed a routine blood parameters-based model with an ACP algorithm that could potentially be applied in the clinic with a PPPM approach for serial monitoring and predicting the occurrence of RD in HM and can facilitate the prevention of HM progression to RD. According to the current study, routine blood measures are essential in patient risk classification, predictive diagnosis, and targeted therapy. Therefore, for high-risk RD persons, novel screening programs and prompt treatment plans are essential to enhance individual outcomes and healthcare offered to the community with HM. The online version contains supplementary material available at 10.1007/s13167-023-00319-3.

MACULAR BUCKLING COMBINED WITH VITRECTOMY AND INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLES WITH MACULAR RETINOSCHISIS WITHOUT RETINAL DETACHMENT IN HIGH MYOPIA.

To investigate the outcomes of macular buckling combined with vitrectomy and inverted internal limiting membrane flap technique for highly myopic full-thickness macular hole (FTMH) with macular retinoschisis. Twenty-six eyes of 26 consecutive patients were retrospectively included. Twelve eyes underwent macular buckling alone (buckling group). Fourteen eyes underwent macular buckling and vitrectomy with an inverted internal limiting membrane flap technique (combination group). Patients were followed for at least 9 months. Rates of FTMH closure and macular retinoschisis resolution, best-corrected visual acuity gained at the final visit were evaluated. The mean follow-up time was 13.00 ± 3.16 months. FTMH closed in six eyes (50%) of the buckling group and 13 eyes (92.86%) of the combination group ( P = 0.026) at the final visit. The macular retinoschisis resolution rate was close between two groups (100% vs. 92.86%; P = 1.000). Both groups achieved significant improvement in best-corrected visual acuity (10.42 ± 17.25 and 16.36 ± 10.39 Early Treatment Diabetic Retinopathy Study letters; P = 0.014 and P < 0.001). The combination group achieved slightly more best-corrected visual acuity improvement, but the difference fell short of significance ( P =0.312). Combination of macular buckling and vitrectomy with the inverted internal limiting membrane flap technique could achieve a high FTMH closure rate and significant best-corrected visual acuity improvement in FTMH with macular retinoschisis.

Rhegmatogenous Retinal Detachment in High Myopia

Latar Belakang: Miopia tinggi berhubungan dengan pemanjangan bola mata, dan pemanjangan bola mata yang berlebihan dapat menyebabkan peregangan mekanis dan penipisan lapisan koroid dan epitel pigmen retina (RPE), sehingga menyebabkan berbagai perubahan degeneratif retina, salah satunya adalah ablasi retina. Ablasio retina adalah suatu kondisi ketika retina neurosensori terlepas dari RPE dengan miopia tinggi sebagai salah satu faktor risikonya.&#x0D; &#x0D; Tujuan: Melaporkan kasus ablasio retina regmatogenosa dan robekan retina multipel pada pasien miopia tinggi. Melaporkan kasus ablasio retina regmatogenosa dan robekan retina multipel pada pasien miopia tinggi.&#x0D; &#x0D; Metode: Seorang wanita berusia 45 tahun datang ke Rumah Sakit Balimed dengan pandangan kabur mendadak pada mata kiri, ketajaman penglihatan menghitung jari (3/60) dan riwayat miopia tinggi pada kedua mata. Mata kanan S-9.00 dan Mata kiri S-6.00. Pada pemeriksaan oftalmologi ditemukan ablasi retina dan robekan retina multiple pada mata kiri. Dia dirujuk ke Rumah Sakit Mata Ramata Denpasar, dan menjalani pars plana vitrectomy (PPV) dengan injeksi gas C3F8 intravitreal dan endolaser (EL) untuk robekan retina multipel pada mata kiri sekitar 2 minggu kemudian (12 September 2022). Satu bulan setelah vitrektomi, tekanan intraokular normal. Operasi berhasil dilakukan dan pada kunjungan tindak lanjut tampak retina menempel dan terdapat peningkatan tajam penglihatan yaitu 6/38 pada mata kiri.

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.

Inverted multi-layer internal limiting membrane flap for macular hole retinal detachment in high myopia

To investigate the surgical outcomes of pars plana vitrectomy (PPV) combined with inverted multi-layer internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment in high myopia. We retrospectively analysed the medical records of macular hole retinal detachment (MHRD) patients with high myopia. The patients were divided into two groups with different surgical procedure: inverted multi-layer ILM flap group (group 1, 27 eyes) and the ILM peeling group (group 2, 29 eyes). Retinal reattachment rate, macular hole closure rate at last follow-up and BCVA at 6 months post-operation were compared between the two groups. After primary PPV and silicone oil removal, the retinal reattachment rate was 96.3% in group 1 and 93.1% in group 2 respectively at last follow-up, showing no statistically significant difference (odds ratio = 0.525, P = 1.000). All eyes in group 1 had type I macular closure (100%, 27/27), while only 7 eyes (24.1%, 7/29) in group 2 have type I macular hole closure. The difference was statistically significant (odds ratio = 0, P < 0.05). The mean logMAR BCVA both improved significantly at 6 months post-operation compared with pre-operation (t = 4.181, P < 0.001; t = 3.217, P < 0.001), however the difference of post-operation BCVA between the two groups was not statistically significant (t = 0.906, P > 0.05). PPV combined with inverted multi-layer ILM flap could achieve better anatomical outcomes than ILM peeling technique with no significant advantage in functional outcomes.

A Comparison of Face-Down Positioning and Adjustable Positioning After Pars Plana Vitrectomy for Macular Hole Retinal Detachment in High Myopia.

PurposeTo compare the anatomical and functional outcomes of macular hole retinal detachment (MHRD) in high myopia after pars plana vitrectomy (PPV) with face-down positioning and adjustable positioning.MethodsFifty-three eyes from 53 patients with MHRD were analyzed in this study. All patients received PPV with silicon oil for tamponade and then subdivided into 2 groups: 28 were included in a face-down positioning group and 25 were included in the adjustable positioning group. Patients were followed up for at least 6 months. The main outcome was the rate of anatomical macular hole (MH) closure and retinal reattachment. Secondary outcome measures were the best-corrected visual acuity and postoperative complications.ResultsThere was no significant difference in the rate of MH closure (53.6 vs. 72.0%, p = 0.167) and retinal reattachment (100 vs. 96%, p = 0.472) between the face-down group and adjustable group. Compared with the mean preoperative best-corrected visual acuity (BCVA), the mean postoperative BCVA at the 6-month follow-up improved significantly in both groups (p = 0, both). But there was no significant difference in the mean postoperative BCVA (p = 0.102) and mean BCVA improvement (p = 0.554) at 6 months after surgery between the two groups. There was no significant difference in the high intraocular pressure (IOP) after surgery between the two groups (53.6 vs. 44%, p = 0.487). There were no other complications that occurred during the follow-up.ConclusionAdjustable positioning after PPV with silicon oil tamponade for MHRD repair is effective and safe. Face-down positioning does not seem to be necessary for all patients with MHRD.

EVALUATION OF THE EFFICACY OF POSTERIOR SCLERAL CONTRACTION IN THE TREATMENT OF MACULAR HOLE WITH RETINAL DETACHMENT IN HIGH MYOPIA.

To evaluate efficacy of posterior scleral contraction for macular hole with retinal detachment in high myopia. Seventy-three macular hole with retinal detachment eyes were treated with posterior scleral contraction. A strip was sent across inferior-temporal scleral surface to posterior pole, then two ends were led out from nasal-inferior to temporal-superior areas. It was tightened to contract posterior sclera with designed axial length shortening ([10% of preoperative axial length-0.5] mm) after aqueous humor was drained from anterior chamber. Recovery was classified as type I (retinal reattachment with MH bridged) and II (retinal reattachment without MH bridged). Follow-up duration was 25.3 ± 18.0 months. Axial length was 30.01 ± 2.27 mm at preoperation and shortened by 2.57 ± 0.82 mm intraoperatively. At final postoperation, maintained axial length shortening was 1.87 ± 0.92 mm. Forty-six eyes (63.0%) recovered as type I, 26 eyes (35.6%) as type II, and 1 eye (1.4%) unrecovered. Postoperative best-corrected visual acuity (logarithm of minimal angle of resolution) was better than preoperative one (0.85 ± 0.50 [Snellen 20/125] vs. 1.11 ± 0.56 [Snellen 20/250], P < 0.001) with correlation (r = 0.662, P < 0.001) and consistency (Kappa = 0.34, P < 0.001) between two. Best-corrected visual acuity improvement did not differ between recovery types (P = 0.206). Macular hole with retinal detachment was successfully recovered by posterior scleral contraction with axial length shortening. Visual improvement was achieved, correlated, and consistent with preoperative best-corrected visual acuity while independent of recovery types.

Long-Term Outcomes of Retinal Detachment in Phakic Eyes After Implantation of Implantable Collamer Lens V4c for High Myopia Correction.

Aim: To estimate whether implantable collamer lens (V4c ICL) implantation increases the risk of retinal detachment in high myopia comparing with myopes with Rigid Gas-Permeable (RGP) correction.Methods: This prospective study was comprised of an ICL group (704 eyes) and an RGP group (628 eyes). Patients were enrolled according to the inclusion criteria and exclusion criteria, then divided into the ICL group and RGP group. Patients in the ICL and RGP groups received V4c ICL implantation and RGP fitting respectively. Retinal details, spherical equivalent refraction (SE), uncorrected distance visual acuity (UDVA), corrected distance vision acutivity (CDVA), axis length (AL), anterior chamber depth (ACD) and other relevant parameters were recorded at different time points. Rhegmatogenous retinal detachment (RRD) morbidity and incidence, RRD morphology and relevant parameters were analyzed.Results: All enrolled patients were followed for 3–6 years. Patients characteristics before the refractive procedure did not show a statistical difference. At the end of the follow up, all the RD cases were RRD. The RRD morbidity of the ICL group and RGP group was 1.99% (14 eyes) and 0.96% (6 eyes) respectively, which did not show statistical difference (P = 0.12). During the first year after refractive procedure, the RRD incidence of the ICL group was 0.85% (6/704), while this number of the RGP group was 0.16% (1/628). It did not show statistical difference (P = 0.08).Conclusion: Compared with RGP fitting, V4c ICL implantation for high myopia correction does not add RRD risk in the long term. V4c ICL implantation is a safe method for high myopia correction.

Autologous Retinal Free Flap Transplantation for Recurrent Giant Macular Hole Retinal Detachment in High Myopia

ëª©ì  ê³ ë„ê·¼ì‹œì•ˆì—ì„œ 발생한 재발 거대황반원공 망막박리에서 시행한 ìžê°€ë§ë§‰íŒì´ì‹ìˆ ì˜ ìˆ˜ìˆ ì  기법과 ìž„ìƒì  결과를 ë³´ê³ í•˜ê³ ìž 한다. 증례요약 71세 여자 환자가 ê³ ë„ê·¼ì‹œì•ˆì—ì„œì˜ 황반원공에 의한 망막박리 진단하에 ìœ ë¦¬ì²´ì ˆì œìˆ , ë‚´ê²½ê³„ë§‰ë²—ê¹€ìˆ , 원공경계부의 ê´‘ì‘ê³ ìˆ ë° ì‹¤ë¦¬ì½˜ê¸°ë¦„ì£¼ìž ìˆ ì„ 시행받았다. ìˆ˜ìˆ í›„ 4개월째 ì‹¤ë¦¬ì½˜ê¸°ë¦„ì œê±°ìˆ ì„ ì‹œí–‰í•˜ì˜€ê³ , 빛간섭단층촬영검사에서 ë§ë§‰ìœ ì°©ì´ 확인되었다. ìˆ í›„ 8ë „ì§¸ 환자는 ì‹œë ¥ì €í•˜ë¥¼ 주소로 ë‚´ì›í•˜ì˜€ê³ , ì•ˆì €ê²€ì‚¬ì—ì„œ 황반원공에 의한 망막박리 재발이 관찰되었다. 이에 ìœ ë¦¬ì²´ì ˆì œìˆ ì„ ì‹œí–‰í•˜ì˜€ê³ , 박리된 상측 망막의 중간주변부에서 자가망막판 경계의 일부 부위(경첩부)를 ì œì™¸í•œ 나머지 경계를 잘랐다. ì•¡ì²´ê³µê¸°êµí™˜ìˆ í›„ 자가망막판의 경첩부를 주의깊게 분리하여 황반부 위에 ì íƒ„ë¬¼ì§ˆ 한 방울과 함께 위치시킨 후 자가망막판 채취부에 ì•ˆë‚´ë ˆì´ì €ì‘ê³ ìˆ ê³¼ ì‹¤ë¦¬ì½˜ê¸°ë¦„ì£¼ìž ìˆ ì„ 시행하였다. ìˆ í›„ 1주째에 빛간섭단층촬영검사에서 황반원공의 í•´ë¶€í•™ì  폐쇄가 확인되었으며, ìˆ í›„ 9개월이 지난 ì‹œì ê¹Œì§€ ì•ˆì •ì ìœ¼ë¡œ ìœ ì§€ë˜ì—ˆë‹¤. ê²°ë¡ ìž¬ë°œëœ 거대황반원공에 의한 망막박리 환자에서 ìžê°€ë§ë§‰íŒì´ì‹ìˆ ì„ 이용한 ìœ ë¦¬ì²´ì ˆì œìˆ ì€ íš¨ê³¼ì ì¸ 치료 방법으로 ê³ ë ¤í• ìˆ˜ 있다. Keywords: Autologous retinal free flap transplantation, Macular hole, Myopia, Retinal detachment

Inverted Internal Limiting Membrane Flap versus Internal Limiting Membrane Peeling for Macular Hole Retinal Detachment in High Myopia

To compare surgical outcomes between the inverted internal limiting membrane (ILM) flap technique and ILM peeling for macular hole retinal detachment (MHRD) in eyes with high myopia. Multicenter cohort study. We retrospectively reviewed medical records of consecutive patients treated between June 2008 and September 2018 at 7 hospitals and included 100 eyes with MHRD associated with high myopia in our study. All eyes underwent vitrectomy with the inverted ILM flap technique (57 eyes) or ILM peeling (43 eyes) and were followed up for more than 6 months. We estimated odds ratios and their 95% confidence intervals (CIs) for macular hole (MH) closure using multivariate logistic regression analysis. We also examined factors associated with the postoperative best-corrected visual acuity (BCVA) at the final visit using multiple linear regression analysis. Macular hole closure and postoperative BCVA at the final visit. The MH closure rate was significantly higher in the inverted ILM flap group (80.7%) than in the ILM peeling group (37.2%; P < 0.001). Moreover, postoperative BCVA at the final visit was significantly better in the former group (0.88 ± 0.48 vs. 0.99 ± 0.48; P= 0.03). The retinal attachment rate (ILM flap, 91.2%; ILM peeling, 79.5%; P= 0.229) and recovery rates for the external limiting membrane and ellipsoid zone line (ILM flap, 10.9%; ILM peeling, 0%; P= 0.12) showed no significant intergroup differences. After adjustment for age, axis, tamponade substance, and dye for ILM staining, the inverted ILM flap technique was associated strongly and positively with MH closure (odds ratio, 7.14; 95% CI, 2.72-18.7; P= 0.001). Moreover, the inverted ILM flap technique and preoperative BCVA were associated significantly and positively with the postoperative BCVA at the final visit. Our findings suggest that the MH closure rate and postoperative visual outcome for eyes with high myopia-associated MHRD are better with the inverted ILM flap technique than with ILM peeling. Thus, vitrectomy with the inverted ILM flap technique should be considered as the initial surgery for MHRD associated with high myopia.

Vitrectomy with inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia: a systematic review of literature and meta-analysis.

To evaluate the effect of vitrectomy with inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD) in high myopia compared with that of ILM peeling. PubMed, EMBASE, Web of Science, MEDLINE, Ovid, Wan Fang and CNKI were systematically reviewed. The primary outcome parameters were the MH closure rate, retinal reattachment rate and postoperative BCVA. Secondary outcome parameters, included intraoperative or postoperative complications. Seven retrospective comparative studies including 228 eyes were selected. No significant difference was detected in either postoperative BCVA (MD -0.07; 95% CI: -0.17 to 0.03; p = 0.16) or the improvement in postoperative BCVA (MD -0.17; 95% CI: -0.50 to 0.16; p = 0.32) between the ILM flap group and ILM peeling group. The retinal reattachment rate using inverted ILM flap was not significantly different from that using ILM peeling (odds ratio (OR) 2.24; 95% CI: 0.75-6.73; p = 0.15). The MH closure rate was higher with inverted ILM flap than with ILM peeling (OR 11.86; 95% CI: 5.65 to 24.92; p < 0.00001). There was no significant difference in intraoperative or postoperative complications, including concomitant cataract rate (OR 1.22; 95% CI: 0.42-3.58; p = 0.71). The inverted ILM flap technique could contribute to a higher MH closure rate than ILM peeling, but visual improvement was similar. Both surgical methods could obtain a high-retinal reattachment rate with fewer intraoperative and postoperative complications.

Inverted internal limiting membrane insertion combined with air tamponade in the treatment of macular hole retinal detachment in high myopia: study protocol for a randomized controlled clinical trial

BackgroundMacular hole retinal detachment (MHRD) occurs most commonly in high myopia and causes severe visual impairment and greatly reduces the quality of life. The aim of this study is to evaluate the efficacy and safety of inverted internal limiting membrane insertion combined with air tamponade in the treatment of MHRD in high myopia, and also to compare the treatment efficacy with that of the conventional “vitrectomy plus internal limiting membrane peeling plus silicone oil tamponade” method for high myopia-associated MHRD.Methods/designIn this clinical trial, 38 patients with MHRD in high myopia will be randomly assigned to two groups (Group 1: standard 3-port 23-gauge pars plana vitrectomy plus internal limiting membrane peeling plus air-fluid exchange plus silicone oil infusion; Group 2: standard 3-port 23-gauge pars plana vitrectomy plus internal limiting membrane peeling plus inverted internal limiting membrane insertion plus air-fluid exchange). The primary outcome is macular hole closure rate in 3 months after the initial surgery. The secondary outcomes are best corrected visual acuity (BCVA), reattachment rate of retinal detachment, and postoperative complication rate.DiscussionThe study results may help to evaluate the efficacy and safety of inverted internal limiting membrane insertion combined with air tamponade in the treatment of MHRD in high myopia, and also compare the efficacy of the new treatment with the conventional “vitrectomy plus internal limiting membrane peeling plus silicone oil tamponade” method. This trial may provide a novel surgical treatment for MHRD in high myopia with more effectiveness and less pain.Trial registrationClinicalTrials.gov, NCT03383731. Registered on 19 December 2017. Retrospectively registered.

Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study.

The aim of this study was to investigate the efficacy of pars plana vitrectomy with inverted internal limiting membrane (ILM) insertion for macular hole retinal detachment (MHRD) in high myopia. We studied 49 eyes of 49 consecutive patients who underwent vitrectomy for MHRD and were followed for more than 12months postoperatively. Eyes that underwent vitrectomy with inverted ILM insertion from October 2013 to August 2015 were compared with eyes that underwent standard ILM peeling from October 2006 to September 2013. Macular hole closure rate, retinal reattachment, and postoperative visual acuity (VA) at 6 and12months were retrospectively evaluated. This series included 13 eyes in the inverted ILM insertion group and 36 eyes in the standard ILM peeling group. The MH closure rate was significantly better in the inverted ILM group (92 vs 39%) (P = 0.003). The initial and final retinal reattachment rates (92% vs. 86%, and 100% in both groups, respectively) did not differ significantly between groups. Although the mean preoperative VA did not differ significantly between the groups, postoperative VA tended to be better in the inverted ILM group at 12months (P = 0.059). The rate of visual improvement of three or more lines in the inverted ILM insertion group (85%) was higher than that in the standard ILM peeling group (47%) at 12months (P = 0.045). Compared to conventional ILM peeling, inverted ILM insertion has a higher MH closure rate and tendency of better postoperative VA in patients with MHRD.

Multiple Free Internal Limiting Membrane Flap Insertion in the Treatment of Macular Hole-Associated Retinal Detachment in High Myopia

Purpose: The aim of this paper was to evaluate the efficacy of multiple free internal limiting membrane (ILM) flap insertion in the management of macular hole-associated retinal detachment in high myopia. Procedures: Eyes receiving operation for macular hole-associated retinal detachment were retrospectively recruited. Those in the study group received ILM peeling and multiple free ILM flap insertion, while those in the control group received ILM peeling only. Postoperative anatomical outcomes and best-corrected visual acuity were compared between the 2 groups. Results: Twenty-seven eyes of 27 patients were recruited in this study (13 in the study group, 14 in the control group). After the operation, the retina was reattached in all cases in both groups. The macular hole closure rate was 100% in the study group but only 42.9% in the control group (adjusted p < 0.001). The eyes in the study group had better visual improvement (logMAR –0.58 ± 0.43) than those in the control group (logMAR –0.31 ± 0.50) with borderline significance (adjusted p = 0.078). Conclusions: For macular hole-associated retinal detachment in highly myopic eyes, the multiple free ILM flap insertion technique offers an effective way to close macular holes. Whether this result also means better visual outcome remains to be seen.

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...

Observation of single-layered inverted internal limiting membrane flap technique for macular hole with retinal detachment in high myopia

Objective: To compare the outcome of pars plana vitrectomy (PPV) with a single-layered inverted internal limiting membrane (ILM) flap versus PPV with ILM peeling for the treatment of macular hole associated retinal detachment (MHRD) in high myopia. Methods: In a retrospective cohort study, PPV with 2 kinds of adjuvant surgical procedures were used in 35 moderately high myopia eyes with MHRD. These eyes were divided into 2 groups: group 1 (17 eyes) receiving PPV and ILM peeling and group 2 (18 eyes) receiving PPV with a single-layered inverted ILM flap. Anatomical reattachment of the retina, macular hole closure, and best-corrected visual acuity (BCVA) were measured at 6 months after surgery. Results: The retina was successfully reattached in all cases. The difference of the retinal reattachment rate between the two groups was not statistically significant (Fisher's exact test, P=1.000). The rate of macular hole closure was 47.1% in group 1 (8 eyes) and 88.9% in group 2 (16 eyes). The difference of the macular hole closure rate between the two groups was statistically significant (Fisher's exact test, P= 0.012). Significant improvement in logarithm of minimal angle of resolution (logMAR) BCVA was achieved in both groups. There was no difference in the initial, final, or improved logMAR BCVA in the 2 groups. Conclusion: Single-layered inverted ILM flap technique effectively helps close the macular hole in moderately high myopia with MHRD. This may prevent the possible redetachment from the macular hole. (Chin J Ophthalmol, 2017, 53: 338-343).

The development of surgery for macular hole with retinal detachment in high myopic eyes

Treatment of macular hole associated retinal detachment in high myopia has progressively evolved over the years, including the scleral buckling, simple intravitreal gas injection, pars plana vitrectomy (PPV), PPV combined with internal limiting membrane (ILM) peeling or transplantation and so on. Simple vitreous gas injection is less traumatic and good for the patients with small holes and localized retinal detachment. PPV combined with ILM peeling can achieve better treatment effects for small holes with wide retinal detachment. But for large holes with wide retinal detachment, PPV combined with ILM transplantation is necessary to improve the macular holes closure rate. If the ILM has been peeled before, the lens capsule could be a nice substitute for ILM. The scleral surgery can solve the problem of posterior scleral staphyloma and effectively control the elongation of the axial length. However, there is still no one surgery could deal with all the problems of high myopia, we should consider all the circumstances like the size of the macular hole and the range of the retinal detachment to choose the best individualized therapy. Key words: Myopia, degenerative/surgery; Retinal detachment/surgery; Retinal perforations/surgery; Vitreoretinal surgery; Review

A comparison of peripheral retinal degeneration areas in high myopia retinal detachment patients with or without diabetes

Objective To compare the occurrence of peripheral retinal degeneration in high myopic (higher than -6.00 D) retinal detachment patients without diabetes and that with diabetes. Methods Two hundred and eleven eyes of 211 cases of high myopia with retinal detachment were divided into two groups. Group A included 156 eyes of 156 cases of high myopia with retinal detachment but without diabetes. Group B included 55 eyes of 55 cases of high myopia with retinal detachment and with diabetes. The peripheral retina was checked with three-mirror contact lens, especially being examined during vitrectomy surgery. The status of peripheral retinal degeneration were recorded. Results In group A, there were 121 eyes with obvious peripheral retinal degeneration, accounting for 77.56%. In group B, there were 21 eyes with obvious peripheral retinal degeneration, accounting for 38.18%. The difference of incidence of peripheral retinal degeneration between the two groups was statistically significant (χ2=28.66, P=0.000). Conclusion The incidence of peripheral retinal degeneration in patients of high myopia with retinal detachment and with diabetes was significantly lower than that in patients of high myopia with retinal detachment but without diabetes. Key words: Myopia, high; Retinal detachment; Degeneration, peripheral retina; Diabetes

Inner limiting membrane packing for the treatment of macular hole retinal detachment in high myopia

Objective To observe the effect of inner limiting membrane packing for the treatment of macular hole retinal detachment in high myopia. Methods The clinical data of 22 eyes of 22 high myopia patients with macular hole retinal detachment from July 2014 to June 2015 were retrospectively analyzed. All patients underwent 23 G vitrectomy, inner limiting membrane packing and vitreous tamponade with silicone oil in 6 eyes, with C3F8 or air in 16 eyes. The macular hole closure rate and retinal anatomical reattachment rate were observed for 3 months after the surgery. Results In 1 case the inner limiting membrane was not successfully removed and the inner limiting membrane was not successfully packed in 1 case. The macular hole closed and the retina reattached in 19 eyes, and the curative rate was 86.3% (19/22). There were 3 cases accounting for 13.64% (3/22) whose retinas were reattached but the macular holes were not closed. Conclusion Inner limiting membrane packing for the treatment of macular hole retinal detachment in high myopia is effective and most of the eyes don't need to fill with silicone oil. Key words: High myopia; Macular hole; Retinal detachment; Packing, inner limiting membrane

Comparison of clinical efficacy of vitrectomy for macular hole induced retinal detachment in high myopia and for rhegmatogenous retinal detachment with macular hole

Objective To compare the outcomes of vitrectomy and internal limiting membrane peeling for the treatment of macular hole retinal detachment(MHRD) in high myopia and rhegmatogenous retinal detachment with macular hole (RRD+ MH). Methods In this retrospective case-control study, 51 eyes of 51 consecutive patients of retinal detachment with macular hole received standard pars plana vitrectomy with internal limiting membrane peeling and 16% C3F8/silicon oil tamponade. They were divided into two groups. Thirty eyes of MHRD with axial high myopia (the axial length longer than 26.0 mm) were in research group (high myopia group) and 21 eyes of 21 patients with RRD+ MH were in control group (RRD+ MH group). Anatomical closure of macular holes using optical coherence tomography (OCT) and final best-corrected visual acuity (BCVA) were compared between the two groups. Results Anatomical closure of the macular hole confirmed by OCT was achieved in 29 of 30 eyes (96.67%) in the high myopia group, and in 19 of 21 eyes (90.48%) in the RRD+ MH group. There was no statistically significant difference between the two groups (χ2=0.10, P=0.75). In the high myopia group, the mean LogMAR VA was (1.13±0.50) at the final follow-up after the surgery, and it was (1.87±0.55) before the surgery. In the RRD+ MH group, it was(2.00±0.54) before surgery and(1.16±0.51) after surgery. There was no significant statistically difference between the two groups in visual increase (p=0.66). Conclusion Vitrectomy and internal limiting membrane peeling with C3F8/silicone oil tamponade is effective for the treatment of macular hole induced retinal detachment in high myopia and rhegmatogenous retinal detachment with macular hole, with high closure rate of the macular hole and significant visual improvement. Key words: Retinal detachment, high myopia, macular hole; Retinal detachment, rhegmatogenous; Vitrectomy; Peeling, internal limiting membrane