A Comparative Study between Vitrectomy with Internal Tamponade and a New Modified Fiber Optic Illuminated Ando Plombe for Cases of Macular Hole Retinal Detachment in Myopic Eyes

Abstract

Aim. To compare pars plana vitrectomy (PPV) with silicone tamponade or gas (Groups Ia and Ib) and a new modified Ando plombe equipped with a fiber optic light (Group II) for cases with macular hole retinal detachment (MHRD) in high myopic eyes (axial length > 26 mm). Methods. A prospective interventional randomized case series included 60 eyes (20 in each group). Successful outcome was considered if the retina was completely attached at the end of the follow-up period. Complications were identified for each group. Results. Visual acuity improved by 37.31%, 40.67%, and 49.40% in Groups Ia, Ib, and II, respectively. The success rate was 55%, 60%, and 100% in Groups Ia , Ib, and II, respectively, with a statistically significant difference between Groups Ia, Ib, and II (p < 0.001 in Ia, p: 0.002 in Ib). Complications rates were 60%, 45%, and 20% in Groups Ia, Ib, and II, respectively, with a statistically significant difference between Groups Ia and II (p: 0.01). Conclusion. Fiber optic illuminated Ando plombe allows better positioning under the macula and consequently improves the success rate of epimacular buckling in comparison to PPV with internal tamponade in MMHRD.

A New Sutureless Illuminated Macular Buckle Designed for Myopic Macular Hole Retinal Detachment

“…It has a much shorter length of 9 mm in comparison to the 21–29 mm length range of the Ando plombe. Moreover, accurate placement over the region of the fovea containing the hole externally was guaranteed by the use of fibre-optic light [4]. …”

“…The development of a sutureless buckle was the natural next step in the evolution of the fibre-optic-guided macular buckle because of the high rate (15%) of scleral perforation in the macular buckle group in the original series performed by the authors [4]. …”

“…This was similar to the macular hole closure rate in the original series, where it was suggested that even applying the macular Ando plombe alone was probably enough to counteract the anteroposterior traction exerted by the staphyloma. By changing the posterior eyewall from a concave into a convex shape, the retina tends to reattach to the underlying RPE, thus also facilitating the MH closure in some cases [4]. …”

“…With the revival of macular buckling as a noninvasive surgical solution for these cases, several published reports describe a success rate comparable to or even higher than that of pars plana vitrectomy which was considered the preferred surgical procedure for this relatively complicated type of detachment [3, 4]. …”

“…Despite the 100% and 40% rates of retinal reattachment and MH closure, respectively, using the fibre-optic-guided Ando plombe, scleral perforation occurred in 15% of the cases, which was significantly higher than that of the vitrectomy group operated by the same surgeon in a recent study published during 2015 [4]. …”