Retinal detachment associated with macular hole in high myopia: using the vitreous anatomy to optimize the surgical approach.
OBJECTIVE
To evaluate the efficacy of different surgical strategies on the postoperative outcomes of retinal detachments (RDs) associated with macular holes (MHs) in high myopia.


METHODS
Prospective, noncomparative case series.


METHODS
The study included 120 phakic, highly myopic eyes (mean degree of myopia, -22.2+/-4.80 diopters) with RDs and MHs that underwent surgical repair. The patients were divided into 2 groups. Group 1 consisted of 60 eyes with a posterior vitreous detachment (PVD). Mean preoperative visual acuity (VA) was 20/200+/-20/500. Group 2 consisted of 60 eyes with posterior vitreous schisis (PVS). The mean preoperative VA was 20/152+/-20/333. The minimum follow-up was 6 months.


METHODS
The surgical approach was chosen on the basis of the clinical characteristics. Twenty-five eyes of group 1 underwent pneumoretinopexy (group 1A), whereas 35 eyes of group 1 were repaired with vitrectomy (group 1B). Forty-nine eyes of group 2 underwent pars plana vitrectomy (group 2A), whereas 11 eyes of group 2 underwent scleral buckling of the macula (group 2B).


METHODS
Anatomic attachment of the retina and VA.


RESULTS
Retinal reattachment at 6 months was achieved in 23 of 25 (92%) eyes of group 1A, 31 of 35 (88.5%) eyes of group 1B, 45 of 49 (91.8%) eyes of group 2A, and 8 of 11 (72.7%) eyes of group 2B. A significant (P<0.01) improvement of postoperative VA with respect to the preoperative values was observed in all groups. The greatest percentage improvement in postoperative VA was observed in groups 1A and 1B eyes.


CONCLUSIONS
Different surgical approaches can be used to repair myopic RD associated with an MH. The choice between different surgical techniques may depend on vitreoretinal relationships, the extent of chorioretinal atrophic areas, and presence of posterior staphyloma. In our study, eyes with a PVD had significantly better visual outcomes than detachments in eyes with PVS.
Ripandelli
Guido
G
Fondazione G.B. Bietti per lo Studio e la Ricerca in Oftalmologia, Via Pasubio 6, 00195 Rome, Italy. guido.ripandelli@email.it
Parisi
Vincenzo
V
Friberg
Thomas R
TR
Coppé
Andrea Maria
AM
Scassa
Cecilia
C
Stirpe
Mario
M
D000328:Adult; D000368:Aged; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000150:complications*; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012167:Retinal Perforations / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012591:Scleral Buckling; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D041623:Tomography, Optical Coherence; D014463:Ultrasonography; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000000981:diagnostic imaging / Q000473:pathology*
D013459:Sulfur Hexafluoride