Macular buckling versus vitrectomy on macular hole associated macular detachment in eyes with high myopia: a randomised trial

Abstract

Aim: To compare the efficacy of macular buckling (MB) and pars plana vitrectomy (PPV) for full-thickness macular holes (FTMH) and associated macular detachment (MD) in highly myopic eyes.

Methods: Prospective interventional case series of eyes undergoing PPV or MB for FTMH and MD.

Main outcome measures: Best-corrected visual acuity (BCVA) at postoperative month 24. Other measured outcomes include the initial surgical success rate, macular hole closure rate and the progression of myopic maculopathy.

Results: A total of 53 eyes from 53 participants were included in this study (26 participants receiving MB and 27 participants receiving PPV), and finally 49 eyes from 49 participants (25 participants in the MB group and 24 participants in the PPV group) were analysed. At postoperative month 24, the BCVA had improved significantly in those that underwent either MB (p<0.001) or PPV (p=0.04). The difference between the groups was not significant (p=0.653). The surgical failure rate after the primary treatment was significantly higher in the PPV group than the MB group (25.00% vs 4.00%, respectively; p=0.04). The macular closure rate was higher in the MB group compared with the PPV group, but the difference was not statistically significant (64.00% vs 58.33%, respectively; p=0.45). Myopic maculopathy development may be more severe following PPV than following MB surgery.

Conclusion: Patients with high myopia obtained anatomical and functional improvements from either MB or PPV. However, MB achieved a significantly higher success rate in retinal reattachment compared with PPV.

Trial registration number: NCT03433547.

Keywords: retina; treatment surgery.

Figure 1

CONSORT diagram. CONSORT, Consolidated Standards of Reporting Trials.

Figure 2

Development of macular atrophy after laser photocoagulation treatment for a recurrent macular hole (MH) and macular detachment (MD). (A–C) The participant underwent a secondary pars plana vitrectomy (PPV) with laser photocoagulation. (A) Preoperative image shows an MH and an MD, (B) the macular atrophy developed at postoperative 8 months, (C) the macular atrophy had enlarged at the 2-year follow-up. (D–F) A participant who was part of the PPV group. (D) A preoperative image shows an MH and an MD, (E) the retina reattached without MH closure at 1 year and (F) 2-year follow-up. (G–I) A participant who was part of the MB group. (G) A preoperative image shows an MH and an MD, (H) the retina reattached without MH closure at the 1 year and (I) 2-year follow-up.

Figure 3

Optical coherence tomography scans of the participants who underwent either macular buckling (MB) or pars plana vitrectomy (PPV) surgery and whose macular hole (MH) was successfully closed. (A) A preoperative image showing an MH and macular detachment (MD) from a participant from the MB group. (B) An image at the 6-month follow-up after MB surgery shows the retina was reattached with MH closure. (C–E) The 1-year, 1.5-year and 2-year follow-up images. (F) A preoperative image showing an MH and an MD from a participant from the PPV group. (G) An image at the 6-month follow-up after PPV surgery shows the retina was reattached with MH closure. (H–J) The 1-year, 1.5-year and 2-year follow-up images; the infrared fundus image shows the appearance and enlargement of patchy atrophy.

Figure 4

Progression of myopic maculopathy after pars plana vitrectomy (PPV) or macular buckling (MB). (A) A preoperative fundus photograph of a participant who underwent PPV without patchy atrophy. (B–D) The 1-year, 1.5-year and 2-year follow-up fundus photographs showing the development of patchy atrophy. (E) A preoperative fundus photograph of a participant who underwent MB. (F–H) The 1-year, 1.5-year and 2-year follow-up fundus photographs showing the retinal pigment epithelium changes within the buckle area. (I and J) Postoperative fundus photographs showing macular atrophy after laser photocoagulation during PPV. (K and L) Postoperative fundus photographs showing patchy atrophy at the edge of the buckle.