Comparison of Reattachment Rate Between Gas and Silicone Oil Tamponade at Primary Vitrectomy with ILM Peeling for Highly Myopic Macular Hole Retinal Detachment

Abstract

Purpose:: The ideal treatment for highly myopic macular hole retinal detachment (RD) is not yet well established. There are some cases to hard to reattach their retina, even though inner limited membrane (ILM) peeling and gas tamponade were done.In this study, we evaluated the reattachment rate at first operation between before and after we changed the strategy of vitrectomy for severe macular hole RD (be confirmed the initiation of proliferative process, elapsed more than a few months from crisis and/or RD overpass the posterior staphyloma) as to inject silicone oil tamponade at first operation.

Methods:: Two groups of eyes (group A; 40 eyes of 40 patients operated in 1997-2001, Group B; 14 eyes of 14 patients operated in 2002-2004) with macular hole RD complicated with posterior staphyloma had been operated.Operation procedure for all cases were following, vitrectomy, posterior vitreous membrane ablation, remove fragments of vitreous cortex as much as possible, peel off ILM within the confines of posterior staphyloma using dye staining with indocyanine green (ICG)(dye staining afterward 2000) and tamponade with perfluoropropane (C₃F₈) or silicone oil. Silicone oil was extracted approximately 6 months after operation in all cases. All patients were highly recommended to be face down position for a several weeks until entire gas tamponade was assimilated.

Results:: The follow-up duration was from 6 months to 5 years. Group A was operated with C₃F₈ tamponade. Three cases that had retinal redetachment were reoperated with silicone oil tamponade. Two of these cases, RD were within posterior staphyloma lesion, however it took several weeks to come to hospital from crisis. In the other case, RD was overpassing the Posterior staphyloma. All cases have remained to reattach their retina with reoperation.In group B, primary tamponade were selected, C₃F₈ for fresh, no proliferation and/or detachment within the macular lesion cases (n=6) and silicon oil for severe cases (n=8). All cases have been remaining reattachment. There was no significant difference between each tamponade cases for ocular axial length (P=0.56) and visual acuity of after surgery (P=0.06)(paired Student t-test).In group A and B respectively 92.5% and 100% reattachment rate were found at first operation.

Conclusions:: Indication of the tamponade selection has to be discussed carefully, however the vitrectomy plus primary silicone oil tamponade with ILM peeling for severe macular hole RD appears to be a viable option for higher reattachment rate.

Keywords: macular holes • retinal detachment • vitreoretinal surgery