PPV has better anatomic outcomes for macular hole in high myopia vs. gas injection alone

Ophthalmology. 2009;116(6):1182-1187.

Visual outcomes may be similar in highly myopic patients managed with gas injection alone for retinal detachment secondary to macular hole when compared with patients managed surgically, but injection alone may be insufficient to attain retinal reattachment.

According to a prospective, randomized, controlled, multicenter study following 231 eyes of 231 patients, retinal reattachment was more successful at 12 months among patients undergoing pars plana vitrectomy (PPV) with gas tamponade (74.5%) compared with patients managed with intravitreal perfluoropropane (C3F8) gas (59.8%; P = .029).

In addition, 24.7% of patients managed with gas injection alone required reoperation and 12% required two or more additional surgeries; by comparison, 18.9% of patients undergoing PPV required reoperation and 4.1% required two or more additional surgeries.

In logistic regression analysis, PPV and low height of retinal detachment at baseline were independently associated with greater surgical success rates. There was no difference in success of surgeries in subgroup analysis of patients undergoing successful PPV with respect to concomitant internal limiting membrane peeling.

Cost of surgery was lower in patients treated with gas injection alone, and several intraoperative complications were more reported in patients undergoing PPV, including iatrogenic retinal tear and injury to the crystalline lens. However, "PPV with intraocular C3F8 tamponade was more efficacious than intravitreal C3F8 injection alone in treating patients with retinal detachment associated with macular holes in patients with high myopia," the study authors said.