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Surgery for foveal detachment in highly myopic patients may prevent macular hole
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WAIKOLOA, Hawaii — Vitreous surgery may be advisable for the correction of foveal detachment in highly myopic eyes at high risk of developing a macular hole, according to a retina specialist speaking here.
“Macular holes in highly myopic eyes are usually associated with retinal detachment. They often have a poor surgical success rate and poor visual outcomes,” said Shoji Kishi, MD. He spoke here at the Retina 2005 meeting, held during Hawaii 2005, The Royal Hawaiian Eye Meeting.
Dr. Kishi said this approach is particularly relevant in Japan because of the high incidence of myopia there.
He and colleagues studied highly myopic patients with posterior staphyloma who had experienced a recent decrease in vision. Optical coherence topography revealed foveal detachment and retinoschisis in these patients, he said.
The study included 11 eyes of nine patients with an average age of 57. Most of the patients were women. The average preoperative visual acuity was 0.17, and the average refractive error was –14.4 D. Seven of the 11 eyes had posterior vitreous detachments.
The surgeons performed core vitrectomy, removed the premacular membrane and then removed the internal limiting membrane. Intraoperative Kenalog (triamcinolone acetonide, Bristol-Myers Squibb) was used.
The surgeons demonstrated during surgery the presence of residual vitreous cortex in all cases. They hypothesized that removing the remaining cortex at an early stage could help prevent the development of a macular hole in high myopia.
By performing vitrectomy and removing all the residual cortex, Dr. Kishi said, they were able to successfully reattach the fovea in all eyes. Only one of the 11 eyes went on to develop a macular hole. Some eyes took longer than others for reattachment to occur, he said, but by around 6 months all patients experienced improvement in visual acuity. Postoperative VA was on average 0.48.
“After surgery, visual acuity was greatly improved. If (the patient) had good preoperative visual acuity, it remained good after surgery,” Dr. Kishi said.