Scleral Resection Technique Combined with Vitrectomy for a Macular Hole Retinal Detachment in Highly Myopic Eyes

Abstract

Purpose: To evaluate scleral resection technique combined with vitrectomy for macular hole retinal detachment of highly myopic eyes. Materials and Methods: Seventeencases (17 eyes) of macular hole retinal detachment in highly myopic eyes, in which the patient underwent vitrectomy combined with scleral resection technique formacular hole retinal detachment between January 1996 and December 2003 at Fukuoka University Chikushi Hospital, were studied.Following pars plana vitrectomy, as much as possible of the residual vitreous and/or epiretinal membrane was removed. A scleral resection was performed in 2 quadrants of the equatorial region of the temporal sclera. Finally, a fluid-air exchange with SF₆ gas injection was performed to achieve retinal attachment. Pre- and postoperative axial length of the eyeballs were measured by B-scan ultrasonography. Results: All cases had the retina reattached at the initial surgery, and visual acuities were stabilized or improved after the surgery. The posterior staphyloma became obscure in 13 out of 17 eyes (76.8%). The macular hole closed in 14 of 17 eyes (82.4%) ophthalmoscopically. There were no cases in which retinal redetachment occurred during follow-up periods of more than 6 months. Conclusion: In cases of macular hole retinal detachment of a highly myopic eye, scleral resection technique combined with vitrectomy changed the shape of the eyeballs and allowed successful retinal reattachment at the initial surgery.

Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques

“…Since the introduction of three-port PPV with gas tamponade in the 90s [11, 12], several surgical strategies have been developed for the MH repair in high myopic eyes, including silicone oil tamponade, episcleral posterior buckling, suprachoroidal buckling, and scleral shortening technique [52–55].…”

Posterior scleral reinforcement for the treatment of myopic traction maculopathy

“…A variety of surgical options are currently available for the treatment of MTM [ 3 ]. These include intraocular surgeries—pars plana vitrectomy (PPV) combined with silicone oil or gas tamponade [ 4 ] with or without internal limiting membrane peeling—and extraocular surgeries—posterior scleral reinforcement (PSR) [ 5 ] and combined surgery [ 6 ]. However, there is increasing evidence [ 7 ] that the outcomes of a single intraocular surgery are often unsatisfactory.…”

Epiretinal large disc of blue‐stained lyophilized amniotic membrane to treat complex macular holes: a 1‐year follow‐up

“…2000; Kono et al. 2006), or more recently ab interno , mostly using (Al Sabti et al. 2009) or repeeling (Hillenkamp et al.…”

“…Following macular cryopexy, which is restricted to recurrences of MHinduced RRD in HM eyes (Feman et al 1974;Laatikainen & Harju 1983), many surgical techniques have been designed to reduce the size of the absolute central scotoma: perifoveolar laser photocoagulation (Harris et al 1984), tapping the MH edges (Kumar et al 2013), arcuate retinotomy on the MH margin (Charles et al 2013). Other surgeons sought to achieve MH closure without retinopexy, either ab externo (Sasoh et al 2000;Kono et al 2006), or more recently ab interno, mostly using (Al Sabti et al 2009) or repeeling (Hillenkamp et al 2007), inverted flap (Michalewska et al, 2010a(Michalewska et al, , 2010b) and autologous transplantation (Morizane et al 2014). More marginally, some authors have proposed to induce macular detachment (Szigiato et al 2016) or to use an autologous retinal transplant (Grewal & Mahmoud 2016), or a lens capsular flap transplant (Chen & Yang 2016).…”