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      Scleral Resection Technique Combined with Vitrectomy for a Macular Hole Retinal Detachment in Highly Myopic Eyes

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          Purpose: To evaluate scleral resection technique combined with vitrectomy for macular hole retinal detachment of highly myopic eyes. Materials and Methods: Seventeencases (17 eyes) of macular hole retinal detachment in highly myopic eyes, in which the patient underwent vitrectomy combined with scleral resection technique formacular hole retinal detachment between January 1996 and December 2003 at Fukuoka University Chikushi Hospital, were studied.Following pars plana vitrectomy, as much as possible of the residual vitreous and/or epiretinal membrane was removed. A scleral resection was performed in 2 quadrants of the equatorial region of the temporal sclera. Finally, a fluid-air exchange with SF<sub>6</sub> gas injection was performed to achieve retinal attachment. Pre- and postoperative axial length of the eyeballs were measured by B-scan ultrasonography. Results: All cases had the retina reattached at the initial surgery, and visual acuities were stabilized or improved after the surgery. The posterior staphyloma became obscure in 13 out of 17 eyes (76.8%). The macular hole closed in 14 of 17 eyes (82.4%) ophthalmoscopically. There were no cases in which retinal redetachment occurred during follow-up periods of more than 6 months. Conclusion: In cases of macular hole retinal detachment of a highly myopic eye, scleral resection technique combined with vitrectomy changed the shape of the eyeballs and allowed successful retinal reattachment at the initial surgery.

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          Retinal detachment associated with a macular hole in severely myopic eyes.

          To investigate factors associated with extensive retinal detachment in severely myopic eyes with a macular hole. Fifty-two consecutive eyes with a macular hole and severe myopia were retrospectively studied. An extensive retinal detachment, defined as extending beyond the cuff of subretinal fluid, was observed in 37 eyes (71%). Extensive retinal detachment developed in 36 (95%) of 38 eyes with a posterior staphyloma and in one (7%) of 14 eyes without a posterior staphyloma (P<.0001). Extensive retinal detachment also developed in 32 (89%) of 36 eyes with complete posterior vitreous detachment and in five (31%) of 16 eyes without posterior vitreous detachment (P<.0001). Posterior staphyloma rather than anteroposterior vitreomacular traction may contribute to the development of retinal detachment associated with a macular hole in severely myopic eyes.
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              Reopening of macular holes in highly myopic eyes with retinal detachments.

              Gas tamponade with or without vitrectomy is commonly used to treat retinal detachment resulting from a macular hole in a highly myopic eye. Redetachment of the retina occurs frequently, however, and the pathogenesis of redetachment is unclear. One possible mechanism leading to redetachment is tangential traction caused by an epiretinal membrane of the posterior retina.

                Author and article information

                S. Karger AG
                May 2006
                09 May 2006
                : 220
                : 3
                : 159-163
                Department of Ophthalmology, Fukuoka University Chikushi Hospital, Chikushino, Japan
                91758 Ophthalmologica 2006;220:159–163
                © 2006 S. Karger AG, Basel

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                Figures: 2, Tables: 3, References: 18, Pages: 5
                Original Paper


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