Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal

• Published in: American journal of ophthalmology Vol. 131; no. 2; pp. 203 - 207
• Main Authors: Kadonosono, Kazuaki, Yazama, Futoshi, Itoh, Norihiko, Uchio, Eiichi, Nakamura, Satoshi, Akura, Junsuke, Sawada, Hajime, Ohno, Shigeaki
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2001; Elsevier
• Subjects: Aged; Basement Membrane - pathology; Basement Membrane - surgery; Biological and medical sciences; Female; Follow-Up Studies; Humans; Indocyanine Green; Male; Medical sciences; Middle Aged; Myopia - complications; Prone Position; Recurrence; Reoperation; Retinal Detachment - etiology; Retinal Detachment - surgery; Retinal Perforations - complications; Sulfur Hexafluoride - administration & dosage; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Visual Acuity; Vitrectomy; Removal; Human; Retinal detachment; Retinopathy; Vision disorder; Myopia; Maculopathy; Internal limiting membrane; Eye disease; Macular hole; Treatment; Surgery; Refractive error; Complication; Vitrectomy; Technique; Severe
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(00)00728-5

PURPOSE: To examine the efficacy of vitrectomy with internal limiting membrane removal for retinal detachment resulting from a macular hole in highly myopic eyes. METHODS: Eleven consecutive highly myopic eyes (11 patients) with retinal detachment resulting from a macular hole were treated by vitrectomy with removal of the internal limiting membrane, which was stained with indocyanine green and sulfur hexafluoride gas injection. Postoperatively, the patients were instructed to remain prone for 2 weeks. The excised specimens were evaluated with transmission electron microscopy. RESULTS: The mean postoperative follow-up was 9.2 ± 2.3 months (range, 7 to 13 months). In 10 of the 11 eyes (91%) the retina was reattached during the initial surgery. Redetachment occurred in one eye, which was successfully treated during the second surgery. Best-corrected visual acuity improved in all eyes and ranged from 20/400 to 20/50. Pathologic examination showed that the internal limiting membrane and epiretinal tissues were present in all specimens. CONCLUSIONS: The use of indocyanine green staining can facilitate removal of a macular internal limiting membrane and overlying epiretinal membrane, resulting in complete relief of the macular traction. Primary removal of the internal limiting membrane may contribute to a high initial success rate for retinal reattachment and be an important adjuvant to the treatment of retinal detachment resulting from a macular hole in highly myopic eyes.