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Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes.
Retina. 2006 Jan; 26(1):25-31.R

Abstract

PURPOSE

To evaluate the surgical outcome of retinal detachment resulting from a posterior staphyloma-associated macular hole in highly myopic eyes.

METHODS

Fifty-seven consecutive highly myopic eyes with retinal detachment resulting from a posterior staphyloma-associated macular hole diagnosed between January 1993 and June 2003 were retrospectively studied. Anatomical reattachment of the retina and best-corrected visual acuity were measured.

RESULTS

Six different operative methods were used to treat this condition with diverse retinal reattachment rates: long-acting gas tamponade only (12.5%); pars plana vitrectomy (PPV) with long-acting gas tamponade (42.8%); PPV with epiretinal membrane (ERM) peeling and long-acting gas tamponade (50.0%); encircling scleral buckling combined with PPV and long-acting gas tamponade (57.1%); encircling scleral buckling combined with PPV, ERM peeling, and long-acting gas tamponade (40.0%); and encircling scleral buckling combined with PPV and silicone oil tamponade (75.0%). Overall, successful retinal reattachment was achieved in 25 (43.9%) of 57 eyes after the first surgery. However, the ultimate success rate of retinal reattachment was 77.2% (44 of 57 eyes) after subsequent surgery. The mean preoperative visual acuity +/- SEM (in logarithm of the minimal angle of resolution units) was 2.08 +/- 0.55, and the mean postoperative visual acuity +/- SEM was significantly increased to 1.87 +/- 0.54 at the last follow-up (P = 0.038). The major cause of recurrent retinal detachment in the long-acting gas tamponade group was nonclosure of the macular hole. For vitrectomized eyes, the major cause was reopening of the macular hole, even with ERM formation and proliferative vitreoretinopathy. There was no obvious correlation between the extent of the detachment or lens status and the reattachment rate.

CONCLUSIONS

The major causes of recurrent retinal detachment in the long-acting gas tamponade and vitrectomized groups were nonclosure of the macular hole and reopening of the macular hole, respectively. Furthermore, a lesser extent of retinal detachment was not associated with a higher anatomical success rate. More aggressive treatment such as silicone oil tamponade may need to be performed to overcome reduced natural adhesion due to posterior staphyloma with marked chorioretinal atrophy. Failure to initiate aggressive treatment can result in an unsatisfactory outcome and repeated surgery.

Authors+Show Affiliations

Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16395135

Citation

Chen, Yen-Po, et al. "Treatment of Retinal Detachment Resulting From Posterior Staphyloma-associated Macular Hole in Highly Myopic Eyes." Retina (Philadelphia, Pa.), vol. 26, no. 1, 2006, pp. 25-31.
Chen YP, Chen TL, Yang KR, et al. Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes. Retina (Philadelphia, Pa). 2006;26(1):25-31.
Chen, Y. P., Chen, T. L., Yang, K. R., Lee, W. H., Kuo, Y. H., Chao, A. N., Wu, W. C., Chen, K. J., & Lai, C. C. (2006). Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes. Retina (Philadelphia, Pa.), 26(1), 25-31.
Chen YP, et al. Treatment of Retinal Detachment Resulting From Posterior Staphyloma-associated Macular Hole in Highly Myopic Eyes. Retina (Philadelphia, Pa). 2006;26(1):25-31. PubMed PMID: 16395135.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of retinal detachment resulting from posterior staphyloma-associated macular hole in highly myopic eyes. AU - Chen,Yen-Po, AU - Chen,Tun-Lu, AU - Yang,Ken-Ren, AU - Lee,Wen-Hao, AU - Kuo,Ya-Hui, AU - Chao,An-Ning, AU - Wu,Wei-Chi, AU - Chen,Kuan-Jen, AU - Lai,Chi-Chun, PY - 2006/1/6/pubmed PY - 2006/3/8/medline PY - 2006/1/6/entrez SP - 25 EP - 31 JF - Retina (Philadelphia, Pa.) JO - Retina (Philadelphia, Pa.) VL - 26 IS - 1 N2 - PURPOSE: To evaluate the surgical outcome of retinal detachment resulting from a posterior staphyloma-associated macular hole in highly myopic eyes. METHODS: Fifty-seven consecutive highly myopic eyes with retinal detachment resulting from a posterior staphyloma-associated macular hole diagnosed between January 1993 and June 2003 were retrospectively studied. Anatomical reattachment of the retina and best-corrected visual acuity were measured. RESULTS: Six different operative methods were used to treat this condition with diverse retinal reattachment rates: long-acting gas tamponade only (12.5%); pars plana vitrectomy (PPV) with long-acting gas tamponade (42.8%); PPV with epiretinal membrane (ERM) peeling and long-acting gas tamponade (50.0%); encircling scleral buckling combined with PPV and long-acting gas tamponade (57.1%); encircling scleral buckling combined with PPV, ERM peeling, and long-acting gas tamponade (40.0%); and encircling scleral buckling combined with PPV and silicone oil tamponade (75.0%). Overall, successful retinal reattachment was achieved in 25 (43.9%) of 57 eyes after the first surgery. However, the ultimate success rate of retinal reattachment was 77.2% (44 of 57 eyes) after subsequent surgery. The mean preoperative visual acuity +/- SEM (in logarithm of the minimal angle of resolution units) was 2.08 +/- 0.55, and the mean postoperative visual acuity +/- SEM was significantly increased to 1.87 +/- 0.54 at the last follow-up (P = 0.038). The major cause of recurrent retinal detachment in the long-acting gas tamponade group was nonclosure of the macular hole. For vitrectomized eyes, the major cause was reopening of the macular hole, even with ERM formation and proliferative vitreoretinopathy. There was no obvious correlation between the extent of the detachment or lens status and the reattachment rate. CONCLUSIONS: The major causes of recurrent retinal detachment in the long-acting gas tamponade and vitrectomized groups were nonclosure of the macular hole and reopening of the macular hole, respectively. Furthermore, a lesser extent of retinal detachment was not associated with a higher anatomical success rate. More aggressive treatment such as silicone oil tamponade may need to be performed to overcome reduced natural adhesion due to posterior staphyloma with marked chorioretinal atrophy. Failure to initiate aggressive treatment can result in an unsatisfactory outcome and repeated surgery. SN - 0275-004X UR - https://www.unboundmedicine.com/medline/citation/16395135/Treatment_of_retinal_detachment_resulting_from_posterior_staphyloma_associated_macular_hole_in_highly_myopic_eyes_ L2 - http://dx.doi.org/10.1097/00006982-200601000-00005 DB - PRIME DP - Unbound Medicine ER -