Macular hole with central retinal detachment in high myopia with posterior staphyloma.

Abstract

Advanced chorioretinal atrophy and vascular sclerosis are common findings in high myopia, particularly in association with a posterior staphyloma. Cystic macular degeneration followed by hole formation is therefore more common in eyes with high myopia than in other eyes, and probably most frequent in cases of high myopia with posterior staphylomata, a fact which does not appear to have been pointed out before. Macular holes in posterior staphylomata are very likely to be missed, and it may be impossible to diagnose them for various reasons: (i) Difficult ophthalmoscopy with deep posterior staphylomata.(2) Lack of contrast at the bottom of deep staphylomata with extreme chorioretinal atrophy.(3) The general difficulty of diagnosing all macular holes. This is borne out by the clinical "disappearance" of the hole after drainage of the subretinal fluid in cases of posterior staphylomata with macular hole and central retinal detachment.In my experience all cases of macular holes in posterior staphylomata have been associated with central retinal detachment. The hole may have been present for a long time before the central retinal detachment developed, and the patients all gave a history thal the affected eye had gradually become weak, with more recent deterioration and obscuration of vision.The clinical diagnosis is relatively easy after the detachment as the hole stands out in contrast to the surrounding grey retina, and parallax with the slit lamp and even with the binocular indirect ophthalmoscope becomes valuable in diagnosis. Macular holes do not necessarily lead to retinal detachment, but all the macular holes in cases of central retinal detachment occurred in patients with deep posterior staphylomata. I have not seen a case of macular hole and central retinal detachment in eyes without staphylomata except in association with peripheral retinal breaks and peripheral detachment, in which the diagnosis of a macular hole is very doubtful even after slit-lamp fundoscopy (Rosengren, I966). Rosengren stated that most cases were excessively myopic and that the elevation affected only the posterior parts of the fundus while the periphery remained intact. He did not mention posterior staphyloma though it appears that the condition was present in all his cases.The diagnosis of central retinal detachment due to a macular hole witn a deep posterior staphyloma is very difficult with direct ophthalmoscopy; the thinned central retina stretches across the cavity of the deep posterior staphyloma which is filled with subretinal

Retinoschisis: a predictive factor in vitrectomy for macular holes without retinal detachment in highly myopic eyes

“…Macular holes and associated retinal detachments (MHRD) are relatively specific to patients with high myopia, which is believed to be caused by tangential traction on the retinal surface by the vitreous cortex or epiretinal membranes within the posterior staphyloma 1 2. Surgical results are relatively poor because of chorioretinal atrophy and poor anatomical success rates postoperatively 3–5…”

Heavy Versus Standard Silicone Oil in the Management of Retinal Detachment With Macular Hole in Myopic Eyes

“…All eyes had staphyloma of type 1 (posterior pole staphyloma) or type 2 (macular staphyloma), as for the classification of Curtin 24 and widespread chorioretinal atrophy. The median follow-up was 11.9 months (range, [9][10][11][12][13][14][15] …”

“…1,2 Other hypotheses developed later include tangential traction, [3][4][5][6][7] posterior staphyloma, and retinal pigment epithelium atrophy. [8][9][10] Current treatment options for myopic macular hole with RD that have replaced the episcleral macular buckling 11 include injection of an expansible gas with or without laser therapy around the macular hole 12 with or without pars plana vitrectomy (PPV). More recently, vitrectomy accompanied by removal of the epiretinal membrane and internal limiting membrane (ILM) has been described.…”

Permanent Buckling for Retinal Detachment due to Macular Hole

“…We found it most satisfac tory particularly in the treatment of lesions in highly myopic eyes with posterior staphy loma. These are the cases where retinal de tachments with macular holes are more fre quent and buckling procedures over the macular area more difficult [1,5,6], The postoperative reaction is not greater than in other types of buckling procedures. The small size of the indenter does not inter fere with ocular motility ( fig.…”