Finally, silicone oil was filled in all patients. Fluid–gas exchange with drainage of subretinal fluid through the MH was performed. After being stained with indocyanine green (ICG) for 30 s, the ILM was peeled over the entire macular area and inserted into the MH to fill the hole. Peripheral vitreous base vitrectomy was performed under scleral depression. Core vitrectomy was performed by intravitreal injection of triamcinolone acetonide to visualize the vitreous gel and the posterior hyaloid. Pars plana vitrectomy (PPV) procedures were performed using a standard 25-gauge 3-port system (Constellation, Alcon, USA). The presence of an MH, MH closure, and retina reattachment were evaluated in the OCT images (Optovue, USA). The area of the RD was determined by the images from a panoramic scanning laser ophthalmoscope (SLO) (Optos, Scotland), which was used to classify patients into those whose RD was within or beyond the vascular arcade. The AL was measured using a Master 500 (Carl Zeiss, Germany). The decimal BCVA was converted to the logarithm of the minimum angle of resolution (logMAR) units for statistical analyses. All the patients accepted the preoperative and postoperative examinations that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, AL, B-ultrasound, fundus photography, and OCT. The following general information was obtained for analysis: sex, age, systemic diseases, and bilaterality. Those eyes with previous vitreoretinal surgery, ocular trauma, and presence of peripheral retinal breaks before surgery, diabetic retinopathy, and other proliferative vitreoretinopathy were excluded. The inclusion criteria were as follows: (1) eyes with an axial length (AL) ≥26 mm (2) the diagnosis of MRHD confirmed by optical coherence tomography (OCT) before surgery, and RD extending by more than 1 disk diameter around the full-thickness MH and (3) the follow-up time is more than 6 months. ![]() The study followed the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of Qingdao Eye Hospital of Shandong First Medical University. This retrospective study analyzed a consecutive series of 53 eyes (53 patients) with MHRD in high myopia who underwent primary PPV between January 2018 and December 2019 at Qingdao Eye Hospital. The purpose of the current study was to evaluate the 6-month outcomes of adjustable positioning compared to face-down positioning after PPV for MHRD in high myopia. However, MHRD is excluded from their observation. Multiple groups have reported the efficacy of postoperative positioning without the maintenance of a face-down positioning after vitrectomy for MH ( 22, 25– 30) and retinal detachment (RD) ( 31– 35). Furthermore, some rare postoperative complications, like ulnar nerve palsies, pulmonary embolism, thrombophlebitis, and decubitus, would develop after a long period of face-down position ( 23, 24). Elderly patients or patients with systemic diseases have serious difficulties persisting in the face-down positioning. However, it is a tough challenge for most patients to keep a strict face-down positioning after operation for a long time. More than 90% of vitreoretinal surgeons worldwide recommend some period of face-down positioning after macular hole (MH) repair surgery ( 22). ![]() first presented the inverted ILM flap technique ( 6), modified techniques, such as temporal ILM flap or inverted ILM insertion, have been introduced to potentially improve the surgical outcomes in MH and MHRD ( 7– 20), or to enhance the success rate in eyes with persistent full-thickness macular hole undergoing secondary PPV ( 21). Vitrectomy combined posterior vitreous cortex removal, epiretinal membrane removal, and ILM removal, with gas or silicone oil tamponade to become the standard treatment for MHRD with a higher retinal reattachment rate ( 5). Since it was first described by Gonvers and Machemer, pars plana vitrectomy (PPV) procedures have been used in the surgical treatment of MHRD with high myopia ( 4). In addition, the weakened retinal adherence to the posterior pole caused by choroidal and retinal pigment epithelium (RPE) atrophy is also one of the factors ( 3). The pathogenesis of MHRD is not completely clear however, it is believed that the tangential macular traction by the vitreoretinal interface, remnants of the cortical vitreous, inflexible internal limiting membrane (ILM), and the retinal vasculature is one of the factors ( 1, 2). Macular hole retinal detachment (MHRD) is a serious vision impairment complication associated with high myopia.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |