Myopic macular holes without surrounding pathology have better outcomes

Patients with high myopia and macular holes and no retinal detachment have better visual outcomes compared with patients with high myopia and a macular hole and a localized retinal detachment with surrounding retinoschisis and with patients with high myopia with a macular hole and a retinal detachment within the area of posterior staphyloma and no retinoschisis, according to Yasushi Ikuno, MD.

"Closure is very important for improvement in the visual acuity," said Dr. Ikuno, of the Department of Ophthalmology, Osaka University Medical School, Osaka, Japan. "There are two important problems to consider with myopic macular holes, the first of which is why the macular hole closure rates differ so greatly and range from 10% to 100%, and the second is that the foveal conditions vary considerably before surgery."

Dr. Ikuno and colleagues conducted a retrospective study in which they reviewed the records of patients who had undergone vitrectomy for highly myopic macular holes. The surgical outcomes were determined by the best-corrected visual acuity; the macular hole closure rate that was confirmed by optical coherence tomography (OCT). Thirty-nine eyes of 39 patients with myopic macular holes were included; all patients had been diagnosed using OCT. All patients had undergone vitrectomy, internal limiting membrane peeling, and gas tamponade.

Eight patients had a macular hole and no retinal detachment or schisis (group 1); 23 eyes had a macular hole with a localized retinal detachment with surrounding retinoschisis (group 2), and eight eyes had a retinal detachment with posterior staphyloma and no retinoschisis (group 3).

Dr. Ikuno reported that group 1 had the most favorable visual outcomes. Groups 2 and 3 had similar outcomes that were not as good as group 1. Groups 2 and 3 had low postoperative visual acuities and a low rate of macular hole closure, although the rate in group 2 was higher than that in group 3. The visual improvement did not differ significantly in groups 2 and 3, perhaps suggesting that other factors, such as retinal damage from a retinal detachment and/or myopic chorioretinal atrophy, have a negative impact on the outcomes.

"OCT performed preoperatively can predict the surgical success rates and the visual acuity outcomes," Dr. Ikuno said. "The absence of a retinal detachment and schisis and macular hole closure are important to favorable visual and anatomic outcomes in these cases of myopic macular holes."