Efficacy of new emerging surgical approaches for macular hole retinal detachment in myopic patients; a systematic review

ABSTRACT

Introduction: Despite recent developments, surgical treatment of retinal detachment secondary to macular hole (MHRD) in myopic patients remains a challenge. This review aims to compare the success rate of two recently emerged surgical approaches: internal limiting membrane (ILM) peeling or inverted flap with intraocular tamponade as surgical treatment for MHRD in high myopia.

Areas covered: This article primarily includes the following sections: literature searches, selection study and assessment, inclusion and exclusion criteria, and statistical analysis. Fifteen studies covering 362 patients were included and reviewed to compare the success rate of different surgical approaches, ILM peeling vs. inverted flap and intraocular tamponade as an adjunct to pars plana vitrectomy (PPV) for treatment of MHRD.

Expert opinion: There is evidence that the anatomical surgical success rate (macular hole closure and retinal reattachment) of the PPV with inverted ILM flap is higher than the conventional ILM peeling. Also, regarding the proper intraocular tamponade, long-term types have increased the success rate of surgery, so perfluoropropane (C3F8) and silicone oil (SO) are preferred over sulfur-hexafluoride (SF6). So, this review introduces PPV combined with inverted ILM flap and adjuvant long-term intraocular endotamponade as mainstream surgical methods for MHRD in myopic patients.

KEYWORDS:

• Macular hole
• pathologic myopia
• silicone oil
• pars plana vitrectomy
• retinal detachment

Article highlights

• MHRD mainly develops in high myopia, especially with posterior staphyloma and is more prevalent in Asian race and female gender.

• The hypothesized pathophysiologic mechanisms are tangential vitreoretinal traction and the presence of a posterior staphyloma with coexisting RPE atrophy in myopic eyes; whereas some researchers believe that vitreous changes play a fundamental role in MHRD.

• MH closure as a criterion for surgical success in MHRD is higher in PPV + inverted ILM flap technique compared to the conventional PPV + ILM peeling.

• In myopic MHRD, because of the atrophic RPE and lack of retinochoroidal coagulation maneuver around the hole, it is critical to support the retina with a long-term intraocular tamponade to restore the integrity between the RPE and neurosensory retina.

• The proposed surgical procedure in the management of MHRD in myopic patients is PPV + ILM flap + SO endotamponade assisted with double staining using triamcinolone acetonide and BBG.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.