title: Removal of adherent cortical vitreous plaques without removing the internal limiting membrane in the repair of macular detachments in highly myopic eyes.
abstract: OBJECTIVE
  To report anatomic and visual improvement after vitrectomy with removal of adherent plaques of vitreous and gas tamponade in highly myopic eyes with detachments over posterior staphylomata.
  
  
  METHODS
  Eyes with retinal detachment over staphylomata were treated with vitrectomy and vitreous cortex removal. Adherent plaques of vitreous were invariably found on the detached retina and were easier to identify with the aid of intraocular triamcinolone. Removal of the vitreous plaques and placement of long-acting gas affected surgical repair. Outcome measures included best-corrected visual acuity and retina reattachment confirmed by biomicroscopic appearance and optical coherence tomography findings.
  
  
  RESULTS
  Six eyes of five consecutive patients were treated. The mean preoperative best-corrected visual acuity was 20/100, and the mean time of documented detachment was 21 months. The internal limiting membrane was not removed in any patient. After surgery, all patients' retinas remained attached during the mean follow-up period of 19.1 months. At the end of the follow-up period, the mean best-corrected visual acuity was 20/60, an improvement that was statistically significant (P = 0.027).
  
  
  CONCLUSIONS
  Retinal detachment over staphylomata in highly myopic eyes appears to be tractional from unresolved forces caused by adherent plaques of vitreous. Removal of the vitreous, without removing the internal limiting membrane, can reattach the retina and lead to anatomic and visual acuity improvements.
authors.affiliation: LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, and the Vitreous-Retina-Macula Consultants of New York, New York 10021, USA. rickspaide@yahoo.com
authors.forename: Richard F
authors.initials: RF
authors.lastname: Spaide
authors.forename: Yale
authors.initials: Y
authors.lastname: Fisher
mesh_terms: D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000150:complications* / Q000175:diagnosis; D012160:Retina / Q000502:physiology; D012163:Retinal Detachment / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000473:pathology / Q000601:surgery*