Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula.
OBJECTIVE
To evaluate the postoperative status of the macula after vitreous surgery with internal limiting membrane removal for macular hole related retinal detachment in patients with severe myopia.


METHODS
Interventional case series.


METHODS
We prospectively examined 10 eyes with retinal detachment associated with a myopic macular hole from 10 consecutive patients, and performed pars plana vitrectomy with internal limiting membrane peeling. Macular buckling was performed in one eye during the initial treatment and in three eyes during subsequent operations. The main outcome measures were the anatomic reattachment rate and the postoperative status of the macular hole. We examined the macular area pre- and postoperatively with slit-lamp biomicroscopy and with a scanning laser ophthalmoscope. Cross-sectional imaging of the macular area was conducted with optical coherence tomography.


RESULTS
Successful retinal reattachment was achieved in seven eyes (70%) after the initial surgery and in three eyes (30%) after additional procedures. Visual acuity remained unchanged in two eyes (20%), and improved by two or more logarithmic units of minimum angle of resolution (logMAR) measurement in eight eyes (80%). The macular hole was anatomically closed in only one eye (10%). Postoperative enlargement of the macular hole was observed in seven eyes.


CONCLUSIONS
In highly myopic eyes with macular hole related retinal detachment, closure of the macular hole is difficult to attain despite the complete relief of tangential traction by internal limiting membrane peeling. Results indicate the presence of a possible imbalance between the retina and the choroid-sclera complex associated with axial elongation and posterior staphyloma in highly myopic eyes.
Ichibe
Mikio
M
Department of Ophthalmology, Niigata University School of Medicine, Asahimachi, Niigata, Japan. ichibem@med.niigata-u.ac.jp
Yoshizawa
Toyohisa
T
Murakami
Kenji
K
Ohta
Masayuki
M
Oya
Yoshimi
Y
Yamamoto
Susumu
S
Funaki
Shigeo
S
Funaki
Haruko
H
Ozawa
Yumi
Y
Baba
Eriko
E
Abe
Haruki
H
D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007368:Interferometry; D008027:Light; D008266:Macula Lutea / Q000503:physiopathology*; D008875:Middle Aged; D009216:Myopia / Q000150:complications*; D009887:Ophthalmoscopy; D011446:Prospective Studies; D012163:Retinal Detachment / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012167:Retinal Perforations / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012591:Scleral Buckling; D014054:Tomography; D014792:Visual Acuity; D014821:Vitrectomy