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Surgery for Myopic Macular Hole Without Retinal Detachment

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Published Online: Aug 5th 2012 European Ophthalmic Review, 2012;6(4):204-7 DOI:
Authors: Jose Garcia-Arumi, Anna Boixadera, Vicente Martinez-Castillo, Miguel Angel Zapata, Carme Macià
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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.


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


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.

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The authors have no conflicts of interest to declare.


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




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