Clinical observation of posterior staphyloma marginal retinal photocoagulation in vitrectomy for macular hole retinal detachment in high myopia_Chinese Journal of Ocular Fundus Diseases

Authors：

He Guanghui , Tian Ge ,  Chen Song , Wu Bin , Dong Meng , Zhang Xiaotian , Wang Meng , Wu Guannan

Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, The Ophthalmic Clinical College of Tianjin Medical University, Tianjin 300020, China;

Corresponding author：

Chen Song, Email: chensong9999@126.com

Keywords：

Myopia, degenerative; Retinal perforations; Retinal detachment; Laser coagulation; Vitrectomy

DOI：

10.3760/cma.j.cn511434-20210310-00129

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Objective To observe the outcome of posterior staphyloma (PS) marginal retinal photocoagulation in pars plana vitrectomy (PPV) for high myopia macular hole retinal detachment eyes accompanied with PS.Methods From January 2017 to June 2019, 49 patients (49 eyes) with high myopia macular hole retinal detachment accompanied with PS who were undergone PPV operation from Tianjin Eye Hospital were included in this study. There were 13 males (13 eyes) and 36 females (36 eyes). All patients underwent best corrected visual acuities (BCVA) and optical coherence tomography examinations. The standard logarithmic visual acuity chart was used for BCVA examination, and the visual acuity was converted to minimum resolution angle in logarithmic (logMAR) when recorded. The patients were randomly divided into two groups according to surgical options: conventional PPV with internal limiting membrane (ILM) peeling (group A, 24 eyes), PS marginal retinal photocoagulation in PPV with ILM peeling (group A, 25 eyes). The mean preoperative logMAR BCVA of group A and B were 1.87±0.28 and 1.80±0.37, the difference was not statistically significant (t=0.604, P=0.551). The patients in the group A received 23G PPV, triamcinolone acetonide staining during the operation, the epiretinal membrane was peeled off, indocyanine green assisted staining, the posterior macular ILM was peeled off, and the peripheral retina was examined in detail during the operation. Areas with retinal degeneration were reinforced by laser photocoagulation, and the subretinal fluid was drained through the macular hole and filled with silicone oil. The eyes of the group B were subjected to retinal photocoagulation for 2 to 3 rows at the edge of the PS in addition to the usual surgical procedures. The average follow-up time was 8.34±3.21 months. Surgical outcome were estimated by the average number of operation, retinal reattachment rate, macular hole closure rate and BCVA. The χ² test or Fisher exact probability was used to compare the count data. Independent sample t test was used to compare the measurement data.Results Retinal reattachment was obtained in 17 eyes (70.8%, 17/24) and 24 eyes (96.0%, 24/25) in group A and B after first surgery respectively, the difference was statistically significant (χ²=3.984, P=0.046). Final retinal reattachment was obtained in all 49 eyes. Final macular hole closure was in 15 eyes (62.5%, 15/24) and 19 eyes (76.0%, 19/25) in group A and B, respectively, the difference was not statistically significant (χ²=1.051, P=0.305). The mean postoperative logMAR BCVA of group A (1.20±0.47) and B (1.08±0.39) were all improved than preoperative BCVA, the differences were all statistically significant (t=2.899, 5.327; P=0.001, 0.000), the differences of mean postoperative logMAR BCVA between two groups was not statistically significant (t=0.675, P=0.506). The mean number of operation of group A (2.63±0.88) was more than group B (2.08±0.28), the difference was statistically significant (t=3.003, P=0.006).Conclusion In comparison with conventional PPV, combined PS marginal retinal photocoagulation can improve retinal reattachment rate after first surgery, and reduce the number of reoperations.

Citation： He Guanghui, Tian Ge, Chen Song, Wu Bin, Dong Meng, Zhang Xiaotian, Wang Meng, Wu Guannan. Clinical observation of posterior staphyloma marginal retinal photocoagulation in vitrectomy for macular hole retinal detachment in high myopia. Chinese Journal of Ocular Fundus Diseases, 2021, 37(4): 271-276. doi: 10.3760/cma.j.cn511434-20210310-00129 Copy

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2.	吕林, 蔡胜诗. 高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗[J]. 中华眼底病杂志, 1998, 14(4): 199. DOI: 10.3760/j.issn:1005-1015.1998.04.001.Lyu L, Cai SS. Vitrectomy and photocoagulation therapy for high myopia macular hole retinal detachment[J]. Chin J Ocul Fundus Dis, 1998, 14(4): 199. DOI: 10.3760/j.issn:1005-1015.1998.04.001.
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6.	Wakabayashi T, Ikuno Y, Shiraki N, et al. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2018, 256(8): 1387-1393. DOI: 10.1007/s00417-018-4046-1.
7.	Laviers H, Li JO, Grabowska A, et al. The management of macular hole retinal detachment and macular retinoschisis in pathological myopia; a UK collaborative study[J]. Eye, 2018, 32(11): 1743-1751. DOI: 10.1038/s41433-018-0166-4.
8.	Kwok AK, Lam SW, Lai TY, et al. Endophotocoagulation to retinal pigment epithelium as an adjuvant therapy in the management of retinal detachment caused by a highly myopic macular hole[J]. Ophthalmic Surg Lasers, 2002, 33(2): 155-157.
9.	Wolfensberger TJ, Gonvers M. Long-term follow-up of retinal detachment due to macular hole in myopic eyes treated by temporary silicone oil tamponade and laser photocoagulation[J]. Ophthalmology, 1999, 106(9): 1786-1791. DOI: 10.1016/S0161-6420(99)90344-5.
10.	Garcia-Ben A, González Gómez A, García Basterra I, et al. Factors associated with serous retinal detachment in highly myopic eyes with inferior posterior staphyloma[J]. Arch Soc Esp Oftalmol, 2020, 95(10): 478-484. DOI: 10.1016/j.oftal.2020.05.013.
11.	Tanaka N, Shinohara K, Yokoi T, et al. Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography[J/OL]. PLoS One, 2019, 14(6): e0218107[2019-06-10]. https://pubmed.ncbi.nlm.nih.gov/31181108/. DOI: 10.1371/journal.pone.0218107.
12.	Matsumae H, Morizane Y, Yamane S, et al. Inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia[J]. Ophthalmol Retina, 2020, 4(9): 919-926. DOI: 10.1016/j.oret.2020.03.021.
13.	Okuda T, Higashide T, Kobayashi K, et al. Macular hole closure over residual subretinal fluid by an inverted internal limiting membrane flap technique in patients with macular hole retinal detachment in high myopia[J]. Retin Cases Brief Rep, 2016, 10(2): 140-144. DOI: 10.1097/ICB.0000000000000205.
14.	Maeno T, Nagaoka T, Ubuka M, et al. New surgical instrument for autologous internal limiting membrane transplantation for the treatment of refractory macular holes[J]. Retina, 2018, 38(3): 643-645. DOI: 10.1097/IAE.0000000000001890.
15.	Ranjbar M, Alt A, Nassar K, et al. The concentration-dependent effects of indocyanine green on retinal function in the electrophysiological ex vivo model of isolated perfused vertebrate retina[J]. Ophthalmic Res, 2014, 51(3): 167-171. DOI: 10.1159/000357284.
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18.	Srivastava GK, Andrés-Iglesias C, Coco RM, et al. Chemical compounds causing severe acute toxicity in heavy liquids used for intraocular surgery[J/OL]. Regul Toxicol Pharmacol, 2020, 110: 104527[2019-11-14]. https://doi.org/10.1016/j.yrtph.2019.104527. DOI: 10.1016/j.yrtph.2019.104527.
19.	宋宗明, 胡旭颋. 高度近视黄斑区玻璃体视网膜界面异常手术治疗中值得探讨的几个问题[J]. 中华眼底病杂志, 2013, 29(2): 121-125. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.002.Song ZM, Hu XT. Disputes revolved about surgeries of macular vitreoretinal interface abnormalities in highly myopic eyes[J]. Chin J Ocul Fundus Dis, 2013, 29(2): 121-125. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.002.
20.	Eibenberger K, Sacu S, Rezar-Dreindl S, et al. Silicone oil tamponade in rhegmatogenous retinal detachment: functional and morphological results[J]. Curr Eye Res, 2020, 45(1): 38-45. DOI: 10.1080/02713683.2019.1652917.

1. 赵秀娟, 吕林. 努力加深对近视牵引性黄斑病变的认识, 合理开展手术治疗[J]. 中华眼底病杂志, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.Zhao XJ, Lyu L. Enhance the cognition of myopic traction maculopathy to select the surgical approach reasonably[J]. Chin J Ocul Fundus Dis, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.
2. 吕林, 蔡胜诗. 高度近视黄斑裂孔视网膜脱离的玻璃体手术和激光光凝治疗[J]. 中华眼底病杂志, 1998, 14(4): 199. DOI: 10.3760/j.issn:1005-1015.1998.04.001.Lyu L, Cai SS. Vitrectomy and photocoagulation therapy for high myopia macular hole retinal detachment[J]. Chin J Ocul Fundus Dis, 1998, 14(4): 199. DOI: 10.3760/j.issn:1005-1015.1998.04.001.
3. Scholda C, Wirtitsch M, Biowski R, et al. Primary silicone oil tamponade without retinopexy in highly myopic eyes with central macular hole detachments[J]. Retina, 2005, 25(2): 141-146. DOI: 10.1097/00006982-200502000-00004.
4. Steidl SM, Pruett RC. Macular complications associated with posterior staphyloma[J]. Am J Ophthalmol, 1997, 123(2): 181-187. DOI: 10.1016/s0002-9394(14)71034-7.
5. Curtin BJ. Posterior staphyloma development in pathologic myopia[J]. Ann Ophthalmol, 1982, 14(7): 655-658.
6. Wakabayashi T, Ikuno Y, Shiraki N, et al. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2018, 256(8): 1387-1393. DOI: 10.1007/s00417-018-4046-1.
7. Laviers H, Li JO, Grabowska A, et al. The management of macular hole retinal detachment and macular retinoschisis in pathological myopia; a UK collaborative study[J]. Eye, 2018, 32(11): 1743-1751. DOI: 10.1038/s41433-018-0166-4.
8. Kwok AK, Lam SW, Lai TY, et al. Endophotocoagulation to retinal pigment epithelium as an adjuvant therapy in the management of retinal detachment caused by a highly myopic macular hole[J]. Ophthalmic Surg Lasers, 2002, 33(2): 155-157.
9. Wolfensberger TJ, Gonvers M. Long-term follow-up of retinal detachment due to macular hole in myopic eyes treated by temporary silicone oil tamponade and laser photocoagulation[J]. Ophthalmology, 1999, 106(9): 1786-1791. DOI: 10.1016/S0161-6420(99)90344-5.
10. Garcia-Ben A, González Gómez A, García Basterra I, et al. Factors associated with serous retinal detachment in highly myopic eyes with inferior posterior staphyloma[J]. Arch Soc Esp Oftalmol, 2020, 95(10): 478-484. DOI: 10.1016/j.oftal.2020.05.013.
11. Tanaka N, Shinohara K, Yokoi T, et al. Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography[J/OL]. PLoS One, 2019, 14(6): e0218107[2019-06-10]. https://pubmed.ncbi.nlm.nih.gov/31181108/. DOI: 10.1371/journal.pone.0218107.
12. Matsumae H, Morizane Y, Yamane S, et al. Inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia[J]. Ophthalmol Retina, 2020, 4(9): 919-926. DOI: 10.1016/j.oret.2020.03.021.
13. Okuda T, Higashide T, Kobayashi K, et al. Macular hole closure over residual subretinal fluid by an inverted internal limiting membrane flap technique in patients with macular hole retinal detachment in high myopia[J]. Retin Cases Brief Rep, 2016, 10(2): 140-144. DOI: 10.1097/ICB.0000000000000205.
14. Maeno T, Nagaoka T, Ubuka M, et al. New surgical instrument for autologous internal limiting membrane transplantation for the treatment of refractory macular holes[J]. Retina, 2018, 38(3): 643-645. DOI: 10.1097/IAE.0000000000001890.
15. Ranjbar M, Alt A, Nassar K, et al. The concentration-dependent effects of indocyanine green on retinal function in the electrophysiological ex vivo model of isolated perfused vertebrate retina[J]. Ophthalmic Res, 2014, 51(3): 167-171. DOI: 10.1159/000357284.
16. Yuan J, Zhang LL, Lu YJ, et al. Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis[J/OL]. BMC Ophthalmol, 2017, 17(1): 219[2017-11-28]. https://pubmed.ncbi.nlm.nih.gov/29179705/. DOI: 10.1186/s12886-017-0619-8.
17. Sørensen NB, Klemp K, Kjær TW, et al. Repeated subretinal surgery and removal of subretinal decalin is well tolerated-evidence from a porcine model[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(9): 1749-1756. DOI: 10.1007/s00417-017-3704-z.
18. Srivastava GK, Andrés-Iglesias C, Coco RM, et al. Chemical compounds causing severe acute toxicity in heavy liquids used for intraocular surgery[J/OL]. Regul Toxicol Pharmacol, 2020, 110: 104527[2019-11-14]. https://doi.org/10.1016/j.yrtph.2019.104527. DOI: 10.1016/j.yrtph.2019.104527.
19. 宋宗明, 胡旭颋. 高度近视黄斑区玻璃体视网膜界面异常手术治疗中值得探讨的几个问题[J]. 中华眼底病杂志, 2013, 29(2): 121-125. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.002.Song ZM, Hu XT. Disputes revolved about surgeries of macular vitreoretinal interface abnormalities in highly myopic eyes[J]. Chin J Ocul Fundus Dis, 2013, 29(2): 121-125. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.002.
20. Eibenberger K, Sacu S, Rezar-Dreindl S, et al. Silicone oil tamponade in rhegmatogenous retinal detachment: functional and morphological results[J]. Curr Eye Res, 2020, 45(1): 38-45. DOI: 10.1080/02713683.2019.1652917.

Chinese Journal of Ocular Fundus Diseases

Clinical observation of posterior staphyloma marginal retinal photocoagulation in vitrectomy for macular hole retinal detachment in high myopia

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