THE MACULAR BUCKLING PROCEDURE IN THE TREATMENT OF RETINAL DETACHMENT IN HIGHLY MYOPIC EYES WITH MACULAR HOLE AND POSTERIOR STAPHYLOMA

Retinal detachment because of macular hole and an additional break within the staphyloma

PURPOSE

To report the finding of retinal detachment because of macular hole and an additional break within the posterior staphyloma.

METHODS

A 63-year-old woman presented with progressive central scotoma of the right eye for 1-month duration. The fundus in the right eye showed retinal detachment that was localized within the posterior staphyloma and macular hole. An additional retinal break was observed within the staphyloma using ophthalmoscope, and optical coherence tomography confirmed that both the breaks were within the staphyloma. Macular buckling was scheduled because the two breaks were close enough to each other and the patient was unable to maintain a prone position.

RESULTS

The retinal detachment was successfully reattached using macular buckling procedure.

CONCLUSION

In the present case, optical coherence tomography proved to be very useful in helping to make the correct diagnosis of a full-thickness break before surgery.

Intravitreal gas injection for macular hole with localized retinal detachment in highly myopic patients

PURPOSE

This study aimed to evaluate treatment effects of intravitreal gas for macular hole with localized retinal detachment (RD) in highly myopic eyes and to examine how the vitreomacular relationship and other factors may influence treatment outcomes.

METHODS

Twenty highly myopic patients with macular holes and localized posterior RD, treated initially with intravitreal injection of C(3) F(8) , were prospectively studied. Recurrent disease was treated with repeated gas injection or vitrectomy according to the extent of detachment. Length of follow-up was ≥ 12 months. Vitreomacular conditions were determined before and within 2 months after gas injection by standard optical coherence tomography. Demographics, refractive errors, axial length, the extent of chorioretinal (CR) atrophy and visual acuity were recorded.

RESULTS

The success rate after primary gas injection was 70%. The remaining 30% of patients achieved anatomic success after further treatment, including vitrectomy with gas or silicone oil tamponade and/or scleral buckling. All cases achieved anatomic success after a mean of 1.4 surgeries. Univariate analysis showed that the patterns of the posterior vitreoretinal relationship did not differ significantly between those successfully treated with gas only (group 1) and those requiring vitrectomy (group 2) (p = 1.000). Logistic regression showed no statistically significant differences in any characteristics between groups 1 and 2.

CONCLUSIONS

Intravitreal gas tamponade alone may achieve anatomic success in more than two-thirds of highly myopic patients with macular holes and localized RD. Patients with different clinical characteristics and vitreoretinal relationships seem to have similar opportunities to achieve reattachment through this relatively non-invasive surgery.

Double peel using triamcinolone acetonide and trypan blue in the management of myopic macular hole with retinal detachment: a case-control study

PURPOSE

To evaluate the safety and efficacy of double peel using triamcinolone acetonide (TA) and trypan blue (TB) in removing epiretinal tissues in vitrectomy for myopic macular hole with retinal detachment (MHRD).

METHODS

Prospective interventional case control study. Patients with myopic MHRD underwent vitrectomy with TA-assisted adherent cortical vitreous (ACV) removal followed by TB-assisted internal-limiting membrane (ILM) peeling and gas tamponade. The results were compared with historical control group without the use of any vital dye or TA.

RESULTS

Ten eyes of 10 study cases were compared with nine eyes of nine control cases. Mean axial length was 28.3 ± 1.4 mm and 29.6 ± 2.4 mm and mean follow-up period was 15 months and 42 months for the study group and the control group, respectively. Reattachment rate was 70% in the study group and 44% in the control group. Mean logMAR visual acuity improvement was 0.02 at 6 months and 0.01 at 12 months for the study group (P < 0.05). Transient intraocular pressure rise was observed in seven eyes in the study group and five eyes in the control group. No other complication was noted.

CONCLUSION

Double peel using TA and TB appeared safe and effective in facilitating removal of ACV and ILM in MHRD. It has higher surgical success rate compared with conventional vitrectomy with epiretinal membrane peeling and gas tamponade.

Pneumatic retinopexy for the repair of retinal detachments: a comprehensive review (1986-2007)

Pneumatic retinopexy has become an important surgical technique in the modern era of retinal surgical management for retinal detachments. It is primarily indicated for uncomplicated retinal detachments with retinal breaks involving the superior 8 clock hours of the fundus, although more complex retinal detachments may be successfully managed with this technique on a selected basis. Qualified candidates must be willing to maintain a specific head posture for five or more days for optimal outcome with pneumatic retinopexy. Basic surgical steps of pneumatic retinopexy include retinopexy of retinal breaks with cryotherapy or laser, intraocular gas injection before or after retinopexy, and maintenance of proper head posture by the patient for the required time period after surgery. Phakic eyes fared better than nonphakic eyes for pneumatic retinopexy, with the single-operation successes of 71-84% for the former and 41-67% for the latter. Despite lower single-operation successes with pneumatic retinopexy in comparison to sclera buckling, the multicenter pneumatic retinopexy trial and other published reports have shown that the final anatomical and visual outcomes are not disadvantaged by the initial pneumatic retinopexy. An extensive discussion of complications associated with pneumatic retinopexy is presented. In addition, a key feature of this review is a comprehensive update in the outcome of pneumatic retinopexy in published reports from 1986 to the present in chronological order not available in the current literature. This comprehensive summary shows updated average surgical outcomes for the 4,138 eyes in the 21-year period to be similar to previous reports: single-operation successes (74.4%), final operation successes (96.1%), new retinal breaks (11.7%), and proliferative vitreoretinopathy (5.2%).

Prognostic factor analysis in pars plana vitrectomy for retinal detachment attributable to macular hole in high myopia: a multicenter study

PURPOSE

To detect the prognostic factors associated with initial reattachment after primary pars plana vitrectomy (PPV) with gas tamponade for retinal detachment attributable to macular hole (MHRD).

DESIGN

Retrospective, multicenter, interventional case series.

METHODS

This study included 49 eyes of 48 patients with MHRD in high myopia (axial length more than 28.0 mm). All eyes underwent PPV with gas tamponade. We retrospectively reviewed the medical records and performed univariate analysis to detect the presence of any difference between eyes with a successful initial reattachment and those that failed. We performed multivariate logistic regression analysis to assess the influence of each preoperative factor on initial success.

RESULTS

Success rate of initial reattachment was 69%. Postoperative best-corrected visual acuity (BCVA) of 34 eyes with initial success was significantly better than those of 15 eyes with initial failure (P < .05); preoperative BCVA was not significantly different (P = .43). The axial length of eyes with initial success (29.26 +/- 0.94 mm) was shorter than that of eyes with initial failure (30.04 +/- 1.49 mm) with borderline significance (P = .049). There were no significant differences noted for other factors such as use of ILM peeling (P = .43) or type of tamponade gas (P = .99). Multiple logistic regression analysis using preoperative factors indicated that only axial length was significantly associated with initial success (odds ratio, 0.49; 95% confidence interval, 0.26 to 0.93; P < .05).

CONCLUSIONS

Initial reattachment is important for visual prognosis, and axial length is a prognostic factor for initial reattachment after PPV with gas tamponade for MHRD in high myopia.

Factors associated with foveoschisis and foveal detachment without macular hole in high myopia

PURPOSE

To investigate the associated factors of foveoschisis and foveal detachment without macular hole in highly myopic eyes.

METHODS

A cross-sectional study of 124 eyes of 68 highly myopic patients was performed. The patients underwent complete ocular examination, fundus photography, and optical coherence tomography (OCT).

RESULTS

Of the 124 eyes, 10 (8%, 10/124) had foveoschisis or foveal detachment without a macular hole on OCT examination. On the basis of univariate analysis, six variables were associated with the pathologic changes, including age over 40 years (P=0.018), spherical equivalent over 10 D (P=0.042), axial length over 31 mm (P=0.001), macular chorioretinal atrophy (P=0.00003), posterior staphyloma (P=0.0003), and vitreoretinal interface factors, including epiretinal membrane, posterior vitreoschisis, and vitreomacular traction (P=0.00002). In the multivariate analysis, three factors were independently associated with foveoschisis and foveal detachment without macular hole in high myopia: axial length, macular chorioretinal atrophy, and vitreoretinal interface factors.

CONCLUSIONS

Foveoschisis and foveal detachment without macular hole are sight-threatening disorders in highly myopic eyes. Axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated with these pathological conditions. Thus, both intraocular and outer ocular wall factors play important roles and merit further study.

Pars plana vitrectomy and perfluoropropane (C3F8) tamponade for retinal detachment due to myopic macular hole: a prognostic factor analysis

PURPOSE

To determine the prognostic factors associated with anatomical success in the treatment of retinal detachment (RD) due to myopic macular hole by pars plana vitrectomy (PPV) and perfluoropropane (C3F8) gas tamponade.

DESIGN

Retrospective, interventional, comparative case series.

METHODS

In an institutional setting, 57 eyes with myopic macular hole RDs treated by PPV and C3F8 tamponade, with or without concomitant internal limiting membrane (ILM) peeling, endolaser photocoagulation, and/or phacoemulsification, were analyzed. Outcome measures were anatomical success, defined as closure of macular hole with reattachment of the surrounding retina, and postoperative best-corrected visual acuity (BCVA).

RESULTS

The mean postoperative follow-up was 26.9 +/- 16.5 months. The anatomical success rate after primary PPV and C3F8 tamponade was 63.2%. Regression analysis showed that shorter axial lengths (odds ratio [OR] = 6.73, 95% confidence interval [95% CI] 1.86 to 12.22, P = .010), concomitant ILM peeling (OR 1.59, 95% CI 1.14 to 2.38, P = .013), and shorter duration of macular hole RD (OR 0.81, 95% CI 0.67 to 0.98, P = .033) were associated with a higher anatomical success. The mean pre- and postoperative BCVAs were 1.430 +/- 0.273 (range, 0.523 to 1.700) and 1.403 +/- 0.271 (range, 0.699 to 1.800) logarithm of minimal angle of resolution units, respectively. The postoperative BCVA was significantly better in eyes with macular hole closure than in eyes without (P = .021).

CONCLUSIONS

Axial length, concomitant ILM peeling, and duration were important prognostic factors for PPV and C3F8 tamponade in the treatment of myopic macular hole RDs.