Progressive retinal detachment secondary to juxtapapillary microholes in association with type 3 posterior staphylomas

Abstract

PurposeThis study describes a novel subtype of retinal detachment occurring in eyes with pathological myopia associated with type 3 posterior staphyloma and discusses the management options.MethodsWe retrospectively reviewed the case notes of seven patients who presented with unilateral symptomatic rhegmatogenous retinal detachment secondary to nasal juxtapapillary microholes.ResultsAll seven patients had pathological myopia and an associated peripapillary type 3 posterior staphyloma. They all presented with symptoms of acute posterior vitreous detachment and had progressive retinal detachment. All cases were discovered to have a single juxtapapillary hole less than 1 disc diameter from the optic-nerve head, within areas of nasal chorioretinal atrophy. The microholes were identified intraoperatively in six of seven cases, with one case identified preoperatively on optical coherence tomography. In the four most recent cases, successful retinal reattachment was achieved with vitrectomy and C2F6 gas tamponade. The remaining three cases were managed with vitrectomy and silicone oil.ConclusionSeven patients with pathological myopia, type 3 posterior staphyloma, and progressive retinal detachment secondary to juxtapapillary microholes are presented in this paper. High clinical suspicion is required to identify these breaks. Successful retinal reattachment with pars plana vitrectomy and long-acting gas is possible.

Characteristics of Peripapillary Staphylomas Associated With High Myopia Determined by Swept-Source Optical Coherence Tomography

“…articles were the analyses of congenital peripapillary changes,[17][18][19][20] and only one article was a report about a peripapillary staphyloma associated with high myopia 21. …”

Amniotic membrane for retinal detachment due to paravascular retinal breaks over patchy chorioretinal atrophy in pathologic myopia

“…Dinah et al 9 treated a cases series of three patients with RD in high myopic eyes with posterior breaks with silicone oil, and in two eyes the silicone oil was never removed.…”

“…Chen et al 10 and Dinah et al 9 proposed an internal approach to RD in high myopic eyes associated with paravascular or juxtapapillary retinal microhole using laser retinopexy around the breaks and long-term gas tamponade with good anatomical results.…”

Retinal detachment due to paravascular abnormalities-associated breaks in highly myopic eyes

“…Benson and Tasman [13] first reported three cases of rhegmatogenous RD caused by paravascular vitreoretinal traction. Dinah et al [7] reported 7 cases of juxtapapillary microholes in high myopic eyes associated with type 3 posterior staphyloma. In all these 7 cases, there was a single hole located within the peripapillary chorioretinal atrophic area, and shallow and stable RD developed shortly after the onset of posterior vitreous detachment.…”

“…Retinal detachment (RD) with posterior breaks in highly myopic eyes has been reported in previous studies [6][7][8]. However, whether the breaks were related to PVAs was never reported.…”