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Francesco Boscia, Giuseppe Lippolis, Fabio Mininni, Luigi Sborgia, Nicola Cardascia; 25-gauge Vitrectomy For Macular Holes With And Without Retinal Detachment In Highly Myopic Eyes. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2753.
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To evaluate the surgical outcome of 25-gauge vitrectomy for macular holes with and without retinal detachment in highly myopic eyes. The 25-gauge equipment is more flexible than the 20-gauge, and the rotational movements of the eye are more difficult.
Eleven consecutive highly myopic eyes (refractive error ≥ -6.00 diopters or an axial length ≥ 25 mm) with a posterior staphyloma-associated macular hole with and without retinal detachment diagnosed between January 2010 and September 2011 were retrospectively studied. Outcome measures were visual acuity (VA), closure of the macular hole using optical coherence tomography (OCT), anatomical reattachment of the retina and complications. The patients’ ages ranged from 40 to 77 years (mean 59.18 years). Six patients were female. The best-corrected visual acuity before vitreous surgery ranged from 2.00 to 0.18 (logMAR) average, 0.45. Three eyes were phakic, and the refractive errors ranged from -6 to -22.0 diopters (average, -13.15 diopters). The axial lengths, measured by A-mode ultrasonography, ranged from 25.25 to 33.27 mm (average, 29.4 mm). Preoperative IOP ranged from 10 mmHG to 18 mmHG (average 14,54 mmHG). Three patients underwent phacoemulsification and intraocular lens implantation. In all cases 25-gauge PPV (Constellation, Alcon) was performed. Core vitrectomy and subsequent peripheral vitreous dissection were performed with triamcinolone visualization. Premacular membrane peeling was carried out utilizing disposable 25-gauge end-grasping forceps Grieshaber). Fluid-air exchange, subretinal fluid drainage, and indocyanine green staining were performed utilizing a soft-tip extrusion needle. In three cases we used as tamponade SF6 24%, in five cases air and in the others silicone oil one thousand centistokes, infused after a complete fluid-air exchange.
After a follow-up of 4.14±1 months (range 3-6) visual acuity was preserved (pre-op 0.45±0.68 logMAR, post-op 0.3±0.43 logMAR, p=0.15). Anatomical closure of the macular hole, confirmed by OCT, and successful retinal reattachment were achieved in all eyes. IOP was stable during the whole follow-up (pre-op 14.55±3.17 mmHg, post-op 16±7.22 mmHg, p=0.55). None of the patients had hypotony ( 25 mmHg). None of the patients had choroidal detachment or endophthalmitis.
Good case selection operated with 25-gauge transconjuctival vitrectomy was shown to ensure good outcomes of efficacy and security similar to 20 gauge transconjunctrival vitrectomy in the management of macular hole with or without retinal detachment in high myopic eyes.
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