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A Journal on Ophthalmology
Minerva Oftalmologica 2010 March;52(1):45-53
Retinal detachment associated with macular hole in high myopia
Ratiglia R., Viola F., Canton V., Giannelli M.
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Dipartimento di Oftalmologia, Milano, Italia
Retinal detachment associated with macular hole (MHRD) accounts for 0.5% of all retinal detachments and it happens mostly in highly myopic eyes. Nowadays, the best treatment for MHRD is still controversial. Various surgical techniques have been described in the literature for the treatment of MHRD. However the most common are pars plana vitrectomy and macular buckling. Macular buckling achieves 90% of anatomical success but it is performed only by few surgeons because of technical difficulties. Pars plana vitrectomy treatment alone is not as efficient as macular buckling, but anatomical results are comparable if associated with internal limiting membrane peeling, that is better performed with the use of vital dyes. Intraocular tamponades are mainly composed by gas (as air, SF6, C2F6 and C3F8) or silicone oil, but so far none of them showed superiority over others. Although pilot studies have shown low success rate of the gas tamponade treatment versus silicone oil tamponade, the latter could cause important side effects and it requires to be removed with a second surgery. Recurrences of MHRD are often treated with vitrectomy tamponaded by oil or macular buckling. Although the surgical techniques lead to retinal reattachment and macular hole closure, visual outcome is often poor due to corioretinal atrophy at the posterior pole.