Clinical features and surgical management of retinal detachment secondary to round retinal holes.
OBJECTIVE
The majority of rhegmatogenous retinal detachments result from pathological posterior vitreous detachment (PVD) and secondary horseshoe or giant retinal tears. Retinal detachment without PVD is usually associated with either retinal dialysis or round retinal holes. This study characterises the features, surgical outcome, and incidence of bilateral involvement of detachment associated with round retinal holes.


METHODS
In all, 110 retinal detachments from 96 consecutive patients with retinal detachment secondary to round retinal holes were studied. Analysis of patient age, sex, refraction, preoperative visual acuity, presented symptoms, position and extent of detachment, number and distribution of holes present, posterior hyaloid membrane status, surgical management, outcome of surgery, and postoperative visual acuity were studied.


RESULTS
The mean age for patients was 34 years with a marked female preponderance (64%) and myopia (83%). The posterior hyaloid membrane remained attached in 95 eyes (86%). In all, 45% patients had bilateral pathology, of which 33% had 'mirror image' distribution. Detachments were predominantly shallow (93%) and slow in progression (17%). A total of 100 detachments were repaired with cryotherapy and scleral buckling, eight with cryotherapy alone, and one with laser retinopexy. In all, 99% detachments were successfully reattached with a single procedure. The mean follow-up period was 2 years. There were no instances of redetachment.


CONCLUSIONS
Round hole detachments are slowly evolving detachments with attached vitreous gel in young, predominantly female myopes. Examination of the fellow eye should be mandatory as there is a high incidence of bilateral pathology. Scleral buckling procedures remained highly effective in this selected group of patients.
Ung
T
T
Vitreoretinal Service Addenbrooke's, NHS Trust, Cambridge CB2 2QQ, UK.
Comer
M B
MB
Ang
A J S
AJ
Sheard
R
R
Lee
C
C
Poulson
A V
AV
Newman
D K
DK
Scott
J D
JD
Richards
A J
AJ
Snead
M P
MP
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D012031:Refractometry; D012163:Retinal Detachment / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D012167:Retinal Perforations / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D012591:Scleral Buckling; D017678:Sex Distribution; D016896:Treatment Outcome; D014792:Visual Acuity; D020255:Vitreous Detachment / Q000150:complications / Q000503:physiopathology / Q000601:surgery