The development and evolution of full thickness macular hole in highly myopic eyes

Abstract

Purpose To evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes. Patients and methods Retrospective observational case series. From 2006 to 2013, clinical records of patients with MH and high myopia who had optical coherence tomography (OCT) before the development of MH were reviewed. All patients had been followed for more than 1 year since MH formation to observe the morphological changes.Results Twenty-six eyes of 24 patients were enrolled. The initial OCT images could be classified into four types: (1) normal foveal depression with abnormal vitreo-retinal relationship (eight cases), (2) macular schisis without detachment (six cases), (3) macular schisis with concomitant/subsequent detachment (nine cases), and (4) macular atrophy with underlying/adjacent scar (three cases). After MH formation, one case in type 1 and one case in type 4 group developed retinal detachment (RD). In type 2 group, four cases developed RD at the same time of MH formation. The preexisting detachment in type 3 group extended in eight cases and improved in one case. Among all the cases, 14 eyes received vitrectomy and 7 eyes received gas injection. MH sealed in nine eyes after vitrectomy and four eyes by gas injection. Conclusion The study revealed four pathways of MH formation in highly myopic eyes. MH from macular schisis tended to be associated with detachment. However, the evolution and the results of surgical intervention were not always predictable.

Clinical characteristics and long-term evolution of lamellar macular hole in high myopia

“…The risk of developing FTMH (25%) was much higher than patients with idiopathic LMH (1%-4%) [5,17]. Similar as our previous report [4], the progression of LMH to FTMH may have achieved through different mechanisms in this group; it may come from (1) tangential premacular traction due to epiretinal membrane (Fig 1L), (2) abnormal vitreofoveal anteroposterior traction ( Fig 1N), and (3) macular atrophy with underlying scar.…”

“…Importantly, the present study revealed that LMH with retinoschisis had a more unstable clinical course compared to MTM (progression rate: 48.5% vs. 17%-28%) [13,21]. As described in the literature [4,6], the evolution of LMH to FD or FTMH in the present study can be further classified into two patterns: (1) formation of focal elevation of the outer retinal layer, leading to FD, with subsequent FTMH formation after rupture of the outer retina; (2) widening and/or deepening of the LMH, leading to FTMH directly. Patients who developed FD were prone to progression into FTMH, so most of them (12 out of 16 eyes, 75%) underwent surgery at this stage.…”

“…Lamellar macular hole (LMH) is a common macular structural abnormality in patients with high myopia (4.8%-20.7%) [1,2]. In highly myopic eyes, the clinical course of LMH may be more complicated than that in idiopathic LMH because the adherent vitreous cortex and epiretinal membrane exert a complex anteroposterior and tangential traction, and because the internal limiting membrane (ILM) is rigid and posterior staphyloma is often present [3][4][5]. Some LMHs may stay unchanged or show minimal progression for many years, while others may progress to full-thickness macular hole (FTMH) or macular hole with retinal detachment (MHRD), causing severe vision loss [6][7][8].…”

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

“…Recently, several mechanisms regarding the development of MH in highly myopic patients were analyzed, and different pathways of MH formation were reported [ 44 ]. In detail, a normal foveal depression with abnormal vitreoretinal relationship characterized the first pathway.…”

Visual Acuity Recovery After Macular Hole Closure Associated With Foveal Avascular Zone Change

“…The univariate regression analyses identified that only the female gender (P = 0.0111) was significantly associated with postoperative FAZ change. In addition to sex, we also included the axial length (univariate analysis, P = 0.1043) to the multivariate analysis, because previous studies suggested that the axial length was a risk factor of MH formation 22,23 and was also associated with the retinal structures. 24 The multivariate analysis also identified that only the female gender (P = 0.0380) was significantly associated with postoperative FAZ change.…”