Pars Plana Vitrectomy and Silicone Oil Tamponade as a Primary Treatment for Retinal Detachment Caused by Macular Holes in Highly Myopic Eyes: A Risk-Factor Analysis

Abstract

PPV/silicone oil tamponade is a practical choice for treatment of MHRD in high myopia. While RDs occasionally re-occur after silicone oil treatment, these events are limited and can be managed with simple measures. A large MH is a risk factor for recurrent RD.

Vitrectomy with Internal Limiting Membrane Repositioning and Autologous Blood for Macular Hole Retinal Detachment in Highly Myopic Eyes

“…Although silicone oil was introduced in the initial surgery to avoid the need for face-down positioning, 21 it is necessary to remove the silicone oil afterward, and longterm retinal toxicity cannot be ignored. 18,22,23 Increasing the successful rate of retinal attachment and hole closure and decreasing the duration that patients are in a prone position are the main goals of MHRD repair.…”

Primary silicone oil tamponade and internal limiting membrane peeling for retinal detachment due to macular hole in highly myopic eyes with chorioretinal atrophy

“…Recent studies on RD caused by a MH treated by PPV plus primary silicone oil tamponade with ILM peeling have suggested a high reattachment rate ranging from 85.1 to 100 % [ 15 – 18 ]. Nishimura et al reported that PPV with ILM peeling and primary silicone oil tamponade without any postoperative position restrictions led to a 92 % retinal reattachment rate after the initial surgery, with a mean duration of silicone oil tamponade of 23.3 months [ 17 ].…”

“…In a retrospective study by Nishimura et al [ 17 ], six clinical factors (age, preoperative BCVA, AXL, area of the RD, combined cataract surgery, and the duration of oil tamponade) were assessed, and all these factors were not correlated with MH closure. Xie et al [ 18 ] assessed clinical risk factors associated with initial anatomical success of MHRD treated with primary silicone oil tamponade with or without ILM peeling, and found that MHRD in myopic eyes with smaller MH diameters were significantly associated with higher initial anatomical successes. The most recent study by Arias et al reported that the area of the fundus autofluorescence and AXL were significantly associated with anatomical outcomes [ 20 ].…”

“…Nishimura et al [ 17 ] reported two eyes with recurrent RD that were treated by MB, both resulting in final retinal reattachment. Xie et al [ 18 ] reported six eyes that experienced recurrences of RD before silicone oil removal. In their study, three of the eyes achieved final retinal reattachment by the patient remaining in a strict prone position for at least 1 week after silicone removal.…”

“…Regarding the study by Xie et al[ 18 ], maintaining a strict prone position postoperatively might provide sufficient compressive force to the macular area, because the surface tension of silicone oil was not sufficient to counteract the stretching force around the MH in myopic eyes, especially in eyes with chorioretinal atrophy. In the present study, we also advised patients to keep a strict prone position postoperatively.…”