touchOPHTHALMOLOGY touchOPHTHALMOLOGY
Retina/Vitreous
Read Time: 2 mins

Surgery for Myopic Macular Hole Without Retinal Detachment

Copy Link
Published Online: Aug 5th 2012 European Ophthalmic Review, 2012;6(4):204-7 DOI: http://doi.org/10.17925/EOR.2012.06.04.204
Authors: Jose Garcia-Arumi, Anna Boixadera, Vicente Martinez-Castillo, Miguel Angel Zapata, Carme Macià
Quick Links:
Abstract
Article
Article Information
Abstract:
Overview

The purpose of this paper is to review the indications, surgical technique and surgical outcome of myopic macular holes (MHs). In myopic MH, the use of optical coherence tomography has been very useful both in the diagnosis and follow-up after surgery due to the difficulty in biomicroscopic diagnosis in high myopes. Myopic MH surgery is more difficult than idiopathic MH surgery due to the increased axial length, retinal pigment epithelium and choroidal atrophy, and thinner retina making internal limiting membrane and posterior hyaloidstaining more important. Myopic MH vitreoretinal surgery achieves comparable anatomical success rates when compared with idiopathic MHs except in cases with posterior staphyloma and axial lengths equal to or over 30 mm where a macular buckle may be needed. The closure of myopic MH decreases the risk of retinal detachment secondary to MH.

Keywords

Myopic macular hole, pars plana vitrectomy, optical coherence tomography, high myopia, foveoschisis, internal limiting membrane peeling, macular buckle

Article:

Asymptomatic Myopic Macular Hole
Secondary macular hole (MH) can occur in eyes with high myopia and the characteristics and demographics of these MHs differ from those of most idiopathic holes. Myopic MHs tend to develop in younger subjects and may be associated with a rhegmatogenous retinal detachment surrounding the hole.1 The mean age of patients in most myopic MH series is mid-fifties, whereas the mean age in idiopathic MH series is the upper sixties. The earlier onset of myopic MHs may be related to abnormal vitreomacular traction in myopic eyes, premature vitreous liquefaction, or other unknown factors predisposing these eyes to premature MHs – there is a predominance in women. The diagnosis may be difficult because of retinal pigment epithelium (RPE) and choroidal atrophy. Biomicroscopic diagnosis of MH in highly myopic eyes without retinal detachment is sometimes difficult. This could be due to a lack of contrast between the MH and RPE, particularly in the presence of a deep posterior staphyloma and severe chorioretinal atrophy. In asymptomatic myopic eyes with good vision, optical coherence tomography (OCT) has revealed the presence of MH.2 Asymptomatic MH is more prevalent in eyes with higher degrees of myopia and pronounced posterior staphyloma. In the authors’ experience of macular examination with optical coherence tomography in severely myopic eyes with posterior staphyloma, the authors have found that retinal detachment, retinoschisis, or both, are often seen at the fovea, suggesting that foveal retinal detachment may precede the onset of MH formation. Also, in these patients apparent complete posterior vitreous detachment (PVD) confirmed by biomicroscopy does not prevent vitreous remnants adhering to theretina, since vitreoschisis and a posterior vitreous cortex adherence has been found to persist. It may also be preceded by a foveal detachmentcausing the fovea to become extremely thin.

To view the full article in PDF or eBook formats, please click on the icons above.

Article Information:
Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Jose Garcia-Arumi, Department of Ophthalmology, Instituto de Microcirugía Ocular, C/ Josep Maria Lladó no 3, 08002, Barcelona, Spain. E: 17215jga@comb.es

Received

2011-10-11T00:00:00

References

  1. Morita H, Ideta H, Ito K, et al., Causative factors of retinal detachment in macular holes, Retina, 1991;11(3):281–4.
  2. Coppé AM, Ripanelli G, Parisi V, et al., Prevalence of asymptomatic macular holes in highly myopic eyes, Ophthalmology, 2005;112(12):2103–9.
  3. Tano Y, Pathologic myopia: where are we now?, Am J Ophthalmol, 2002;134(5):645–60.
  4. Baba T, Ohno-Matsui K, Futagami S, et al., Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia, Am J Ophthalmol, 2003;135(3):338–42.
  5. Takano M, Kishi S, Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma, Am J Ophthalmol, 1999;128(4):472–6.
  6. Gaucher D, Haouchine D, Tadayoni R, et al., Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome, Am J Ophthalmol, 2007;143(3):455–62.
  7. Kobayashi H, Kishi S, Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis, Ophthalmology, 2003;110(9):1702–7.
  8. García-Arumí J, Martinez V, Puig J, Corcostegui B, The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment, Retina, 2001;21(4):332–8.
  9. Curtin BJ, The myopias: basic science and clinical management, Philadelphia, US: Harper and Row, 1985.
  10. Rodrigues EB, Meyer CH, Mennel S, Farah ME, Mechanisms of intravitreal toxicity of indocyanine gren dye: implications for chromovitrectomy, Retina, 2007;27:958–70.
  11. Kwok AK, Lai TY, Yip WW, Vitrectomy and gas tamponade wihout internal limiting membrane peeling for myopic foveoschisis, Br J Ophthalmol, 2005;89:1180–3.
  12. Patel SC, Loo RH, Thompson JT, Sjaarda RN, Macular hole surgery in high myopia, Ophthalmology, 2001;108(2):377–80.
  13. Sulkes DJ, Smiddy WE, Flynn HW, Feuer W, Outcomes of macular hole surgery in severely myopic eyes: a case-control study, Am J Ophthalmol, 2000;130(3):335–9.
  14. Park SS, Marcus DM, Duker JS, et al., Posterior segment complications after vitrectomy for macular hole, Ophthalmology, 1995;102(5):775–81.
  15. 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(2):203–7.
  16. Kumar A, Wagh VB, Prakash G, et al., Visual outcome and electron microscopic features of indocyanine green-assisted internal limiting membrane peeling from macular hole of various aetiologies, Indian J Ophthalmol, 2005;53(3):159–65.
  17. Sayanagi K, Morimoto Y, Ikuno Y, Tano Y, Spectral-domain optical coherence findings in myopic foveoschisis, Retina, 2010;30:623–8.
  18. Suda K, Hangai M, Yoshimura N, Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography, Am J Ophthalmol, 2011;151:118–27.e1.
  19. Kobayashi H, Kobayashi K, Okinami S, Macular hole and myopic refraction, Br J Ophthalmol, 2002;86:1269–73.

Further Resources

Share this Article
Related Content In Retina/Vitreous
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72