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Kwang-Soo Kim, Youngdo Yeo, Yu Cheol Kim; Treatment and Prognosis of Macular Hole Retinal Detachment in Highly Myopic Eyes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5086.
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To evaluate the surgical outcome and visual prognosis of macular hole retinal detachment in highly myopic eyes.
Consecutive 143 eyes with macular hole with or without macular retinal detachment which underwent pars plana vitrectomy were retrospectively reviewed. High myopia was defined as eye with axial length longer than 26 mm or definite posterior staphyloma and 19 eyes were included in this category. Among the high myopic eyes, 12 eyes with macular hole detachment were evaluated. Mean changes of best corrected visual acuity (BCVA), retinal reattachment and macular hole closure status and recurrence were analyzed for anatomical and functional prognosis.
There was a significant difference in the frequency of retinal detachment as 12 eyes of 19 high myopic patient (63.2%) and 2 eyes of 124 non-high myopic patient (1.6%)( p < 0.001). Twelve macular hole detachment in high myopia underwent vitrectomy and (internal lmiting membrane peeling) with silicone oil tamponade in 5 eyes and C3F8 gas tamponade in 7 eyes. All patients followed up for more than 6 months. Retina was successfully reattached in 11 eyes. One eye which had gas tamponade procedure was failed to reattach the retina and after additional vitrectomy with silicone oil tamponade, retina was reattached. Macular hole closure was achieved in 5 eyes and 9 eyes showed improvement of BCVA at least more than two lines on the Snellen chart. Silicone oil was removed in 5 eyes 2 to 6 month after surgery. During the follow-up, retinal detachment was recurred in 2 eyes. After additional gas tamponade in one eye and re-silicone oil tamponade in the other, retina was reattached successfully
The concomitant of retinal detachment is more easily seen in highly myopic eyes with macular hole compared to non-highly myopic eyes. Pars plana vitrectomy with silicone oil or gas tamponade is a useful treatment in macular hole retinal detachment in highly myopic eyes. Partially improvement of BCVA was observed even though in eyes with not fully closed macular hole. High recurrence rate was observed after the primary surgery, the choice of intraocular tamponade and its duration period should be considered carefully.
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