Outcomes of Surgical Treatment for Retinal Detachment in Highly Myopic Eyes with Macular Hole

To determine the type and outcome of surgery for retinal detachment resulting from macular hole in highly myopic eyes.

This retrospective analysis was performed on the medical records of highly myopic patients who underwent surgery for retinal detachment (RD) resulting from macular hole at Labbafinejad Hospital, Tehran-Iran from 1992 to 2001. Variables included age, gender, number and type of operations, visual acuity before and after the procedures and surgical success rate.

Overall, 28 eyes of 27 patients (26 female and one male) with mean age of 59.8±11 years were included. Mean follow-up was 17.3 (range 3-72) months. Mean axial length was 29±2.74mm (range: 24 to 35mm) and mean degree of myopia was -16.4±3.1 D (range -10 to -22 D). Posterior staphyloma was present in 20 eyes (71%). Seven eyes had undergone failed scleral buckling as the primary procedure prior to referral. Intravitreal SF6 injection was the primary procedure in 12 eyes with localized detachments; the retina became attached in 5 (41.6%) of these eyes, however redetachment occurred in 7 (58.4%) eyes. Overall, 23 eyes (including 7 failed scleral buckling cases, 7 redetachments following SF6 injection and 9 cases of primary surgery) underwent vitrectomy with use of high viscosity silicone oil. No major complications occurred during the operations. Overall, final anatomical success was 92.9% and visual improvement occurred in 85.7% of the eyes.

In highly myopic eyes with RD due to macular hole, less invasive procedures such as SF6 injection seem to be appropriate for eyes with localized detachment. In cases of total or subtotal RD and posterior staphyloma, pars plana vitrectomy and silicone oil tamponade seem to be the preferred procedure.