Treatment of macular hole retinal detachment with macular plug in highly myopic eyes: three‐year results

Abstract

To investigate the long-term surgical outcomes of macular hole retinal detachment (MHRD) following vitrectomy with macular plug in highly myopic eyes. Methods: Thirty-five cases of highly myopic eyes with MHRD in 35 patients who underwent an initially successful vitrectomy with macular plug and were followed up for at least 3 years were reviewed. The anatomical outcomes were evaluated by fundus examination, fundus photographs and optical coherence tomography (OCT). Myopic features after the surgery were differentiated according to recommendations of the Meta-analysis of Pathologic Myopia (META-PM) Study Group. The best-corrected visual acuities (BCVAs) before and after surgery were analysed as the functional outcome. Main outcome measures time-course changes in BCVA and complications. Results: The mean patient age was 61.0 AE 11.4 years. The follow-up was 45.2 AE 8.6 months (ranged from 36 to 71 months). The mean axial length was 29.3 AE 1.2 mm. All eyes demonstrated attached retina, but 2 eyes (5.7%) developed reopened macular holes until the last follow-up. Complications of postoperative rhegmatogenous retinal detachment were detected in 2 eyes (5.7%) within 1 year and retina reattached after the secondary vitrectomy. Three cases (8.6%) of prolonged subretinal fluid lasting more than 1 year were detected but finally absorbed completely. Comparing 1-3 years postoperatively, myopic features showed significant progression of myopic maculopathy category (p = 0.035). Functionally, significantly improved BCVA could be maintained postoperatively between 6 months and 3 years. However, vision of 14 eyes (40.0%) worsened within 1-3 years postoperatively, and visual deterioration was associated with progression of myopic maculopathy (p = 0.004) and preexisting disease of glaucoma (p = 0.006). Conclusions: A vitrectomy combined with macular plug provided favourable outcomes in the long term, over the ≥3-year follow-up period.

Intraoperative Perfluorocarbon Liquid Tamponade Technique for Treatment of Extensive Retinal Detachment Secondary to a Myopic Macular Hole

“…Draining the SRF through MH is controversial considering the potential damage to the RPE and macular area. 8,10,13 However, from the report of Hu et al, 9 Ohana et al 12 and our present study, no obvious trauma to the RPE underlying macular area was observed postoperatively by OCT scans.…”

“…The residual SRF post-PPV may lead to persistent retina–RPE nonattachment and undermine visual and anatomical rehabilitation in myopic eyes with poor RPE and choroidal function. 10 Thus, in some reports, SRF was drained during PPV, and ILM peeling and ILM flap technique was performed under the assistance of PFCL around the macula to prevent ILM flap displacement and SRF reaccumulation. 9 , 11 , 12 The new surgical technique described in the present study includes three steps to manage the extensive RD and seal the MH: thorough SRF drainage through the MH with fluid–air exchange to achieve retinal reattachment, prolonged PFCL tamponade to enhance close attachment between the neural retina and the RPE, and management of the attached MH after removal of the PFCL.…”

Persistent Subretinal Fluid After Vitrectomy for Macular Hole–associated Retinal Detachment

“…Compared with traditional ILM peeling technique, the ILM inverted flap can significantly improve the retinal reattachment rate and the macular hole closure rate in MHRD eyes. 30,31 However, multivariate analysis in this study showed that ILM inverted flap was associated with a higher likelihood of persistent SRF. This may be because the ILM inverted flap procedure tends to cause inadequate SRF drainage, particularly in the absence of extramacular retinal holes.…”

Successful surgical treatment of traumatic macular hole with total rhegmatogenous retinal detachment in a child

“…Stretching the tissues over the macula leads to macular hole development. It may also arise from anterior-posterior vitreoretinal tractional forces [5,6].…”