Prognostic Factor Analysis of Vitrectomy for Retinal Detachment Associated with Myopic Macular Holes

Published:October 17, 2013DOI:https://doi.org/10.1016/j.ophtha.2013.08.033

      Purpose

      To describe the anatomic and functional outcomes in a cohort of subjects undergoing vitrectomy for retinal detachment (RD) resulting from myopic macular hole (MH) and to analyze the prognostic and surgical factors predicting retinal reattachment and MH closure.

      Design

      Retrospective case series.

      Participants

      All patients who underwent vitrectomy for RD resulting from myopic MH between 2000 and 2009 at our center.

      Methods

      Case records were reviewed at 6 months after surgery. Retinal reattachment and complete anatomic success, defined as retinal reattachment with MH closure, were assessed. Multivariate logistic regression models, including age, gender, duration of symptoms, spherical equivalent refraction (SE), internal limiting membrane peeling, tamponade choice, and concurrent scleral buckling, were constructed to assess associations with covariates.

      Main Outcome Measures

      Retinal reattachment and complete anatomic success (retinal reattachment with MH closure).

      Results

      In total, 114 subjects were analyzed. Most were women (n = 79 [69.3%]), and the mean age was 57.5±13.3 years. The mean SE was −9.88±6.37 diopters. At 6 months, 98 subjects (86.0%) demonstrated retinal reattachment, of whom 93 subjects required only 1 operation. Complete anatomic success was achieved in 61 subjects (53.5%), of whom 55 needed only 1 operation. Subjects with retinal reattachment had better best-corrected visual acuity (BCVA; mean BCVA, 1.22±0.81 logarithm of the minimum angle of resolution [logMAR] units) than those without (mean BCVA, 1.98±1.26 logMAR units; P < 0.001), and subjects with complete anatomic success had better BCVA (mean BCVA, 1.05±0.87 logMAR units) than those without (mean BCVA, 1.62±0.87 logMAR units; P < 0.001). In multivariate analyses, increasing age and the use of perfluoropropane (C 3F 8) tamponade were predictive of anatomic success (per 1-year increase: odds ratio [OR], 1.049; 95% confidence interval [CI], 1.002–1.099; P = 0.04; and for tamponade: OR, 10.71; 95% CI, 1.08–106.29; P = 0.04).

      Conclusions

      Vitrectomy is effective in the repair of RD resulting from MH in myopic eyes, with retinal reattachment achieved more frequently than MH closure. Retinal reattachment and MH closure are important for improving visual outcomes. Greater age at presentation and use of C 3F 8 are associated with a greater likelihood of anatomic success.

      References

        • Brown G.C.
        Macular hole following rhegmatogenous retinal detachment repair.
        Arch Ophthalmol. 1988; 106: 765-766
        • Howard G.M.
        • Campbell C.J.
        Surgical repair of retinal detachments caused by macular holes.
        Arch Ophthalmol. 1969; 81: 317-321
        • Sasoh M.
        • Yoshida S.
        • Ito Y.
        • et al.
        Macular buckling for retinal detachment due to macular hole in highly myopic eyes with posterior staphyloma.
        Retina. 2000; 20: 445-449
        • Avitabile T.
        • Bonfiglio V.
        • Buccoliero D.
        • et al.
        Heavy versus standard silicone oil in the management of retinal detachment with macular hole in myopic eyes.
        Retina. 2011; 31: 540-546
        • Cho H.
        • Choi A.
        • Kang S.W.
        Effect of internal limiting membrane removal in treatment of retinal detachment caused by myopic macular hole.
        Korean J Ophthalmol. 2004; 18: 141-147
        • Fang X.
        • Zheng X.
        • Weng Y.
        • et al.
        Anatomical and visual outcome after vitrectomy with triamcinolone acedonide-assisted epiretinal membrane removal in highly myopic eyes with retinal detachment due to macular hole.
        Eye (Lond). 2009; 23: 248-254
        • Hong M.C.
        • Wu T.T.
        • Sheu S.J.
        Primary gas tamponade in the management of macular hole with retinal detachment in highly myopic eyes.
        J Chin Med Assoc. 2011; 74: 121-124
        • Ichibe M.
        • Yoshizawa T.
        • Murakami K.
        • et al.
        Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula.
        Am J Ophthalmol. 2003; 136: 277-284
        • Kadonosono K.
        • Yazama F.
        • Itoh N.
        • et al.
        Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal.
        Am J Ophthalmol. 2001; 131: 203-207
        • Kono T.
        • Takesue Y.
        • Shiga S.
        Scleral resection technique combined with vitrectomy for a macular hole retinal detachment in highly myopic eyes.
        Ophthalmologica. 2006; 220: 159-163
        • Kumar A.
        • Tinwala S.
        • Gogia V.
        • Sinha S.
        Clinical presentation and surgical outcomes in primary myopic macular hole retinal detachment.
        Eur J Ophthalmol. 2012; 22: 450-455
        • Kuo C.N.
        • Kuo H.K.
        • Kuo C.J.
        • et al.
        Comparison of primary gas tamponade and a vitrectomy for repair of macular holes with retinal detachment in highly myopic eyes.
        Chang Gung Med J. 2003; 26: 578-585
        • Kwok A.K.
        • Lam S.W.
        • Lai T.Y.
        • Lam D.S.
        Endophotocoagulation to retinal pigment epithelium as an adjuvant therapy in the management of retinal detachment caused by a highly myopic macular hole.
        Ophthalmic Surg Lasers. 2002; 33: 155-157
        • Li K.K.
        • Tang E.W.
        • Li P.S.
        • Wong D.
        Double peel using triamcinolone acetonide and trypan blue in the management of myopic macular hole with retinal detachment: a case-control study.
        Clin Experiment Ophthalmol. 2010; 38: 664-668
        • Liu H.Y.
        • Zou H.D.
        • Liu K.
        • et al.
        Posterior vitreous cortex contributes to macular hole in highly myopic eyes with retinal detachment.
        Chin Med J (Engl). 2011; 124: 2474-2479
        • Gonvers M.
        • Machemer R.
        A new approach to treating retinal detachment with macular hole.
        Am J Ophthalmol. 1982; 94: 468-472
        • Brazitikos P.D.
        • Androudi S.
        • Dimitrakos S.A.
        • Stangos N.T.
        Removal of the internal limiting membrane under perfluorocarbon liquid to treat macular-hole-associated retinal detachment.
        Am J Ophthalmol. 2003; 135: 894-896
        • Christensen U.C.
        • Kroyer K.
        • Sander B.
        • et al.
        Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial.
        Br J Ophthalmol. 2009; 93: 1005-1015
        • Ryan Jr., E.H.
        • Bramante C.T.
        • Mittra R.A.
        • et al.
        Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling.
        Am J Ophthalmol. 2011; 152: 815-819
        • Yoshida M.
        • Kishi S.
        Pathogenesis of macular hole recurrence and its prevention by internal limiting membrane peeling.
        Retina. 2007; 27: 169-173
        • Yu J.
        • Wang F.
        • Cao H.
        • et al.
        Combination of internal limiting membrane peeling and endophotocoagulation for retinal detachment related to high myopia in patients with macular hole.
        Ophthalmic Surg Lasers Imaging. 2010; 41: 215-221
        • Ortisi E.
        • Avitabile T.
        • Bonfiglio V.
        Surgical management of retinal detachment because of macular hole in highly myopic eyes.
        Retina. 2012; 32: 1704-1718
        • Shukla D.
        • Kalliath J.
        • Srinivasan K.
        • et al.
        Management of rhegmatogenous retinal detachment with coexisting macular hole: a comparison of vitrectomy with and without internal limiting membrane peeling.
        Retina. 2013; 33: 571-578
        • Stirpe M.
        • Michels R.G.
        Retinal detachment in highly myopic eyes due to macular holes and epiretinal traction.
        Retina. 1990; 10: 113-114
        • Oshima Y.
        • Ikuno Y.
        • Motokura M.
        • et al.
        Complete epiretinal membrane separation in highly myopic eyes with retinal detachment resulting from a macular hole.
        Am J Ophthalmol. 1998; 126: 669-676
        • Wolfensberger T.J.
        • Gonvers M.
        Long-term follow-up of retinal detachment due to macular hole in myopic eyes treated by temporary silicone oil tamponade and laser photocoagulation.
        Ophthalmology. 1999; 106: 1786-1791
        • Kwok A.K.
        • Cheng L.L.
        • Gopal L.
        • et al.
        Endolaser around macular hole in the management of associated retinal detachment in highly myopic eyes.
        Retina. 2000; 20: 439-444
        • Binder S.
        • Zugner M.
        • Velikay M.
        Does vitrectomy followed by intraocular gas tamponade offer sufficiently effective treatment of retinal detachment due to holes in the posterior pole?.
        Int Ophthalmol. 1987; 11: 25-30
        • O'Driscoll A.M.
        • Goble R.R.
        • Kirkby G.R.
        Vitrectomy for retinal detachments with both peripheral retinal breaks and macular holes. An assessment of outcome and the status of the macular hole.
        Retina. 2001; 21: 221-225
        • Feng L.G.
        • Jin X.H.
        • Li J.K.
        • et al.
        Surgical management of retinal detachment resulting from macular hole in a setting of high myopia.
        Yan Ke Xue Bao. 2012; 27: 69-75
        • Singh A.J.
        Combined or sequential surgery for management of rhegmatogenous retinal detachment with macular holes.
        Retina. 2009; 29: 1106-1110
        • Lam R.F.
        • Lai W.W.
        • Cheung B.T.
        • et al.
        Pars plana vitrectomy and perfluoropropane (C3F8) tamponade for retinal detachment due to myopic macular hole: a prognostic factor analysis.
        Am J Ophthalmol. 2006; 142: 938-944
        • Nakanishi H.
        • Kuriyama S.
        • Saito I.
        • et al.
        Prognostic factor analysis in pars plana vitrectomy for retinal detachment attributable to macular hole in high myopia: a multicenter study.
        Am J Ophthalmol. 2008; 146: 198-204
        • Mancino R.
        • Ciuffoletti E.
        • Martucci A.
        • et al.
        Anatomical and functional results of macular hole retinal detachment surgery in patients with high myopia and posterior staphyloma treated with perfluoropropane gas or silicone oil.
        Retina. 2013; 33: 586-592
        • Pernot A.
        • Fleury J.
        • Bonnet M.
        [Retinal detachment caused by macular holes in patients with severe myopia: results of intravitreal injection of pure C3F8].
        J Fr Ophtalmol. 1996; 19: 491-495
        • Chignell A.H.
        • Billington B.
        The treatment of macular holes by pars plana vitrectomy and internal air/SF6 exchange.
        Graefes Arch Clin Exp Ophthalmol. 1986; 224: 67-68
        • Nadal J.
        • Verdaguer P.
        • Canut M.I.
        Treatment of retinal detachment secondary to macular hole in high myopia: vitrectomy with dissection of the inner limiting membrane to the edge of the staphyloma and long-term tamponade.
        Retina. 2012; 32: 1525-1530
        • Li X.
        • Wang W.
        • Tang S.
        • Zhao J.
        Gas injection versus vitrectomy with gas for treating retinal detachment owing to macular hole in high myopes.
        Ophthalmology. 2009; 116: 1182-1187
        • Carrero J.L.
        Incomplete posterior vitreous detachment: prevalence and clinical relevance.
        Am J Ophthalmol. 2012; 153: 497-503
        • Figus M.
        • Carpineto P.
        • Romagnoli M.
        • et al.
        Optical coherence tomography findings of incomplete posterior vitreoschisis with vitreomacular traction syndrome and impending macular hole: a case report.
        Eur J Ophthalmol. 2008; 18: 147-149
        • Wylegala E.
        • Woyna-Orlewicz A.
        • Pilat J.
        • et al.
        [Traction maculopathies—pathogenesis and diagnostics].
        Klin Oczna. 2006; 108: 457-463
        • Ripandelli G.
        • Coppe A.M.
        • Fedeli R.
        • et al.
        Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes: a comparison [corrected] of vitrectomy versus posterior episcleral buckling surgery.
        Ophthalmology. 2001; 108: 2258-2264
        • Matsuo T.
        • Shiraga F.
        • Takasu I.
        • Okanouchi T.
        Scleral infolding combined with vitrectomy and gas tamponade for retinal detachment with macular holes in highly myopic eyes.
        Jpn J Ophthalmol. 2001; 45: 403-408
        • Brooks Jr., H.L.
        Macular hole surgery with and without internal limiting membrane peeling.
        Ophthalmology. 2000; 107: 1939-1948
        • Uemoto R.
        • Saito Y.
        • Sato S.
        • et al.
        Better success of retinal reattachment with long-standing gas tamponade in highly myopic eyes.
        Graefes Arch Clin Exp Ophthalmol. 2003; 241: 792-796
        • Nishimura A.
        • Kimura M.
        • Saito Y.
        • Sugiyama K.
        Efficacy of primary silicone oil tamponade for the treatment of retinal detachment caused by macular hole in high myopia.
        Am J Ophthalmol. 2011; 151: 148-155
        • Goldbaum M.H.
        • McCuen B.W.
        • Hanneken A.M.
        • et al.
        Silicone oil tamponade to seal macular holes without position restrictions.
        Ophthalmology. 1998; 105: 2140-2147
        • Ikuno Y.
        • Sayanagi K.
        • Oshima T.
        • et al.
        Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes.
        Am J Ophthalmol. 2003; 136: 477-481