Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes.
OBJECTIVE
To evaluate the surgical outcome of retinal detachment resulting from a posterior staphyloma-associated macular hole in highly myopic eyes.


METHODS
Fifty-seven consecutive highly myopic eyes with retinal detachment resulting from a posterior staphyloma-associated macular hole diagnosed between January 1993 and June 2003 were retrospectively studied. Anatomical reattachment of the retina and best-corrected visual acuity were measured.


RESULTS
Six different operative methods were used to treat this condition with diverse retinal reattachment rates: long-acting gas tamponade only (12.5%); pars plana vitrectomy (PPV) with long-acting gas tamponade (42.8%); PPV with epiretinal membrane (ERM) peeling and long-acting gas tamponade (50.0%); encircling scleral buckling combined with PPV and long-acting gas tamponade (57.1%); encircling scleral buckling combined with PPV, ERM peeling, and long-acting gas tamponade (40.0%); and encircling scleral buckling combined with PPV and silicone oil tamponade (75.0%). Overall, successful retinal reattachment was achieved in 25 (43.9%) of 57 eyes after the first surgery. However, the ultimate success rate of retinal reattachment was 77.2% (44 of 57 eyes) after subsequent surgery. The mean preoperative visual acuity +/- SEM (in logarithm of the minimal angle of resolution units) was 2.08 +/- 0.55, and the mean postoperative visual acuity +/- SEM was significantly increased to 1.87 +/- 0.54 at the last follow-up (P = 0.038). The major cause of recurrent retinal detachment in the long-acting gas tamponade group was nonclosure of the macular hole. For vitrectomized eyes, the major cause was reopening of the macular hole, even with ERM formation and proliferative vitreoretinopathy. There was no obvious correlation between the extent of the detachment or lens status and the reattachment rate.


CONCLUSIONS
The major causes of recurrent retinal detachment in the long-acting gas tamponade and vitrectomized groups were nonclosure of the macular hole and reopening of the macular hole, respectively. Furthermore, a lesser extent of retinal detachment was not associated with a higher anatomical success rate. More aggressive treatment such as silicone oil tamponade may need to be performed to overcome reduced natural adhesion due to posterior staphyloma with marked chorioretinal atrophy. Failure to initiate aggressive treatment can result in an unsatisfactory outcome and repeated surgery.
Chen
Yen-Po
YP
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Chen
Tun-Lu
TL
Yang
Ken-Ren
KR
Lee
Wen-Hao
WH
Kuo
Ya-Hui
YH
Chao
An-Ning
AN
Wu
Wei-Chi
WC
Chen
Kuan-Jen
KJ
Lai
Chi-Chun
CC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004108:Dilatation, Pathologic; D019773:Epiretinal Membrane / Q000601:surgery; D005260:Female; D005466:Fluorocarbons / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000150:complications*; D012008:Recurrence; D012163:Retinal Detachment / Q000209:etiology / Q000601:surgery*; D012167:Retinal Perforations / Q000150:complications*; D012189:Retrospective Studies; D012591:Scleral Buckling; D015422:Scleral Diseases / Q000209:etiology*; D012827:Silicone Oils / Q000008:administration & dosage; D013459:Sulfur Hexafluoride / Q000627:therapeutic use; D014603:Uveal Diseases / Q000209:etiology*; D014792:Visual Acuity; D014821:Vitrectomy
D005466:Fluorocarbons; D012827:Silicone Oils; C042852:perflutren; D013459:Sulfur Hexafluoride