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Peter M Kaiser, Justis Ehlers; Retrobulbar Viscoelastic as Adjunct for Highly Myopic Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):4399.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the effectiveness of adjunct retrobulbar viscoelastic in the treatment of highly myopic macular holes.
Retrospective, case series of 12 patients (mean age = 64 years) treated at the Cole Eye Institute with highly myopic macular holes (axial length > 28 mm or refractive error > -6.00 D). The surgical procedure consisted of a 23g pars plana vitrectomy, internal limiting membrane peel with indocyanine green staining followed by retrobulbar application of viscoelastic (Healon GV) via a BD Visitec Sub-Tenon Cannula. Most patients had viscoelastic placement under intraoperative OCT guidance. Post-operative OCT using a Zeiss SD-OCT was performed on post-operative days 1, month 1, and month 3. Pre and post-operative Snellen visual acuity was tabulated as well as any adverse events.
12 eyes of 12 patients were included in the case series. Two patients were re-operations after failed macular hole surgery, and 10 were treatment naïve. Prior to surgery, the mean Snellen visual acuity was 20/170. Post-operatively, 100% of patients had anatomic closure of their macular hole at months 1 and 3. The presence of the viscoelastic was visualized on post-operative day 1 on SD-OCT in most cases. The mean visual acuity significantly improved to 20/55. (two-way correlated sample t-test, t(11) = 3.21, p < 0.05). There were no adverse events noted due to the surgical procedure.
Retrobulbar viscoelastic (Healon GV) can be used as an effective surgical adjunct for highly myopic macular holes as an easier alternative to macular buckle and other posterior support techniques. The surgical success was excellent, but the small sample size should prompt a larger study to establish greater external validity in comparison to other surgical techniques for this difficult surgical issue.
This is a 2020 ARVO Annual Meeting abstract.
Post-op day 1 OCT demonstrating retrobulbar viscoelastic (hypoecho space with arrow) creating posterior imbraction effect to help tamponade the still open myopic macular hole
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