Vitrectomy and scleral imbrication in patients with myopic traction maculopathy and macular hole retinal detachment

Abstract

Purpose: To determine the outcomes of vitrectomy with scleral imbrication in highly myopic eyes with either myopic traction maculopathy (MTM) or macular hole retinal detachment (MHRD).

Methods: The medical records of 17 patients who had undergone vitrectomy with internal limiting membrane (ILM) peeling and scleral imbrication for MTM or MHRD were reviewed. The best-corrected visual acuities (BCVAs), the axial length, the macular hole (MH) closure rate, and the shape of the posterior segment determined by optical coherence tomography were evaluated. Three-dimensional magnetic resonance imaging (3D-MRI) was also performed on five eyes.

Results: The postoperative BCVA improved significantly from 0.76 ± 0.39 logarithm of the minimum angle of resolution (logMAR) units to 0.53 ± 0.35 logMAR units (P = 0.0004). The axial length decreased from 29.42 ± 1.81 mm to 27.97 ± 1.71 mm at 1 month. The MTM was resolved or decreased in all eyes. The MH was closed in 44 % of the MHRD eyes, and the retina was reattached in all of the MHRD eyes. The horizontal distance between the optic disc and the bottom of the posterior staphyloma was significantly decreased at 1 month (P = 0.012) but not at later times. The 3D-MRI images showed a reduction in the distance between the bottom of the posterior staphyloma and the center of the eye (P = 0.029) and a flattening of the posterior staphyloma (P = 0.010).

Conclusions: Vitrectomy with ILM peeling and scleral imbrication may be helpful in treating MTM and MHRD by reducing the degree of curvature of the posterior staphyloma.

Keywords: Macular hole retinal detachment; Myopic traction maculopathy; Optical coherence tomography; Scleral imbrication; three-dimensional magnetic resonance imaging.

Fig. 1

Horizontal optical coherence tomography (OCT) image showing how the different parameters of a posterior staphyloma and optic disc were measured. The height and length of the staphyloma are defined as the horizontal and vertical lengths from the temporal edge of the optic disc to the plane of the bottom of the retinal pigment epithelial layer, respectively

Fig. 2

Preoperative and postoperative three-dimensional magnetic resonance images of case 2. The corneal apex (A) is defined as the point farthest from the plane of the corneal limbus. The central axes (AB line) of the eye is defined as a line that intersects the plane of the corneal limbus perpendicularly. The center (C) of the eye is selected to be 12.5 mm posterior from the peak of the cornea along the central axis. D. The bottom of the posterior staphyloma is defined as the point farthest from the center of the eye within the staphyloma. Indicated are the nasal edge (E), temporal edge (F), and width (EF) of the posterior staphyloma. The postoperative image shows an infolding of the eye globe by the scleral imbrication (white arrowhead) and the decrease of the axial length of the eye

Fig. 3

Preoperative and postoperative fundus photographs and optical coherence tomography (OCT) images of case 2. a. Preoperative fundus photograph and (b) OCT image showing macular retinoschisis and foveal detachment. The posterior surface (arrowheads) is extruded posteriorly due to a posterior staphyloma. c. Postoperative photograph and (d) OCT at 6 months shows a resolution of the macular retinoschisis and foveal detachment. The posterior surface (arrowheads) is flattened postoperatively

Fig. 4

Preoperative and postoperative ultra-wide-field fundus images and optical coherence tomography (OCT) images of case 8. a. Preoperative ultra-wide-field fundus image and (b) OCT image show the macular hole retinal detachment (arrowheads). The posterior surface (arrowheads) is extruded posteriorly due to a posterior staphlyoma. c. Postoperative ultra-wide-field fundus image at 6 months showing retinal attachment and scleral infolding (arrowheads) at the temporal quadrant. d. Postoperative OCT image shows retinal reattachment with residual subretinal fluid. The posterior curvature (arrowheads) is flatter postoperatively

Fig. 5

The mean axial length at baseline and at 1 month and the final visit after scleral imbrication. The mean axial length is decreased significantly at 1 month and the final visit from the baseline (Wilcoxon signed-rank test)

Fig. 6

The correlation between the shortened axial length and the bite width of the mattress suture for scleral imbrication. The shortened axial length from the baseline is not significantly correlated with the baseline axial length and the bite width of the mattress suture for scleral imbrication

Fig. 7

The change of the shape of the posterior staphyloma. The length of the bottom of the posterior staphyloma from the optic disc decreases significantly at 1 month but those at 3 and 6 months are not significant. The height of the bottom of the posterior staphyloma from the optic disc decreases postoperatively but the decrease is not significant

Fig. 8

Preoperative and postoperative three-dimensional magnetic resonance imaging (3D-MRI) images. 3D-MRI images show posterior extrusion of the eye preoperatively in all eyes. The postoperative images show the infolding caused by the scleral imbrication (white arrowheads) and the decrease of the axial length of the eye. The curvature of the posterior surface of the staphyloma became less extruded posteriorly after surgery