Macular hole and myopic refraction

Abstract

Aim: To study a correlation between age at the onset and myopic refraction and axial length in patients with idiopathic macular hole and to evaluate a correlation of the size and surgical outcome of macular hole with axial length. Methods: In a prospective clinical study, 94 eyes of 91 patients with stage III and IV idiopathic macular hole were enrolled. A standardised surgical protocol was performed using vitrectomy and gas tamponade. This study evaluated the size of macular hole and the rate of anatomical and functional success of surgery. To assess dimensions of macular hole, confocal laser scanning tomography was employed.Results: Age at the onset showed a significant increase in relation to myopic refraction and axial length (r = 0.689, p <0.0001; r = 0.723, p <0.0001). Mean age was 52. I n the age related macular holes, vitreoretinal surgical techniques have been used to close macular holes based on theory that the tangentially oriented contraction of the premacular vitreous cortex is involved in the pathogenesis of macular holes.1-3 The procedure for repairing a macular hole involves the removal of the premacular cortical vitreous and the performance of intraocular gas tamponade. Theories regarding the mechanisms by which closure of macular hole occurs include the release of vitreous traction and the formation of a glial scar. [1][2][3][4][5][6][7][8][9][10] Highly myopic individuals are known to be a high risk group for macular holes. The early stages of age related macular holes have been described, 1-10 but it is uncertain whether the degree of myopic refraction may influence the development of macular hole. 12The objective of the present study was to study the effect of myopic refraction on the development of macular hole. We also investigated a relation between refractive error and the size of macular hole, and anatomical and visual improvement of surgery. MATERIALS AND METHODS PatientsWe studied 94 eyes of 91 Japanese patients with idiopathic full thickness stage III and IV macular holes who had symptoms present for 6 months or shorter and were scheduled to undergo macular hole surgery. Any patient with pre-existing ocular disease (that is, trauma, chronic inflammatory, or neoplastic disorders) or previous surgery were excluded as were those with systemic disorders (diabetes, uncontrolled hypertension) or a known life threatening disease at enrolment into the study. Patients were informed of the purpose of our study and provided written informed consent. Macular holes were diagnosed based on the results of slit lamp biomicroscopy with a precorneal lens, indirect ophthalmoscopy, and fluorescein angiography. A macular hole was defined as a full thickness, sharp-edged retinal defect with an elevated rim and retinal striae in the foveal area with a hyperfluorescent window defect visible on fluorescein angiography.

Macular thickness as determined by optical coherence tomography in relation to degree of myopia, axial length and vitreous chamber depth in Malay subjects

“…This agrees with previous studies that have demonstrated specific pathological features involving the macular area in subjects with higher degrees of myopia. 12,13 It is also noted that there is a trend for thickening at the fovea in high myopia but there seem to be individual variations and the result is not statistically significant.…”

“…10 High myopes also tend to have chorioretinal atrophy at the posterior pole, 10 choroidal neovascularisation at the macular area 12 and a macular hole at the posterior pole. 13 Of late, the retinal changes in increasing degrees of myopia have been studied with the technique of optical coherence tomography (OCT). The outer macula (perifovea) has been demonstrated using OCT to be thinner in myopes.…”

Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case-control study using optical coherence tomography

“…In a case series of high myopia with macular hole, García-Arumí et al [5] reported an 87.5% primary anatomical closure rate after operation, while Patel et al reported a rate of only 60% with a single operation in highly myopic eyes [6]. Case-control studies by Sulkes et al., Kobayashi et al, and Kwok et al did not reveal significant differences in macular hole closure rates between highly myopic and non-highly myopic eyes [7][8][9]. However, they all used biomicroscopy alone to evaluate the results and defined only flattening of the edges or resolution of cuff of subretinal fluid as surgical success [5][6][7][8][9].…”

Assessment of macular retinal thickness and volume in normal eyes and highly myopic eyes with third-generation optical coherence tomography

“…18 The elevated foveola and fovea area in young, healthy highly myopic eyes might explain the high incidence of macular hole, which may be associated with retinal detachment, myopic traction maculopathy, and foveoschisis. 10,11,[19][20][21][22][23] Figure 2 OCT scans of the macula (both eyes) in normal eyes (a) and highly myopic eyes (b) including the colour scale and scan schematic. The foveola and fovea (1 mm) were thicker but the inner macular area (3 mm) and outer macular area (6 mm) were thinner in highly myopic eyes.…”