A New Approach to Treating Retinal Detachment with Macular Hole

Vitreous surgery for macular hole-related retinal detachment after phacoemulsification cataract extraction: 10-year retrospective review

“…30,31 However, many of these techniques had a considerable complication rate 31,32 and were accompanied by extensive scarring in the macula with subsequent vision loss. 9 In cases of high myopia with chorioretinal atrophy or a posterior staphyloma, treatment was less effective with earlier techniques because of the absence of retinal pigment epithelium (RPE) in areas of chorioretinal atrophy, leading to reduced natural retinal adhesion and inverse traction produced by posterior enlargement of the staphyloma overcoming retinal adhesion. 27 In this situation, the retina would not have enough elasticity to follow the posterior displacement of the scleral wall.…”

“…27 Selected cases of MHRD in myopic eyes can be treated successfully by air or gas tamponade; however, this technique may be less effective in cases with chorioretinal atrophy and posterior staphyloma. 9 Rosengren first reported intraocular tamponade using an air bubble combined with transscleral diathermy. 33 Kreissig et al 34 closed a posterior retinal hole with an expanding SF6 bubble without drainage of subretinal fluid.…”

“…These investigators obtained a final successful retinal reattachment rate of 91% and removed silicone oil after a mean period of 3 months. Although Kreissig et al 35 used argon or krypton laser coagulation to permanently secure the retina, others 9,26 did not use photocoagulation with equally successful results. Considering that 70% of the eyes in our series had posterior staphylomas and that laser photocoagulation has minimal or no effect in areas of severe RPE deficiency, we did not perform macular photocoagulation.…”

“…4,5 MHRD is believed to arise from tangential traction on the retina by an epiretinal membrane or the inverse traction of the retina that cannot expand along with the posterior enlargement of the staphyloma. [6][7][8][9] As cases of cataract surgeries continue to increase, a higher incidence of MHRD is possible in the future. However, the visual and anatomical recoveries of surgery for MHRD after phacoemulsification have not been evaluated.…”

Krypton yellow laser for the treatment of macular hole in high myopia without retinal detachment

“…In 1982, Gonvers and Machemer first recommended vitrectomy, intravitreal gas, and prone positioning for retinal detachments secondary to macular hole. 1 With refinements in surgical techniques, more and more vitreoretinal surgeons have offered surgical intervention to afflicted patients because of the potential for better visual outcomes. In fact, a greater than 90% anatomic success rate may be achieved through surgery for retinal detachments due to macular holes.…”