Efficacy of combining posterior scleral contraction and intravitreal C3F8 injection in high myopia with macular hole retinal detachment

Abstract

Aim: To evaluate the efficacy and safety of combining posterior scleral contraction (PSC) with intravitreal perfluoropropane (C₃F₈) injection in high myopia with macular hole retinal detachment (MHRD).

Methods: A total of 22 participants (22 eyes) with high myopia [axial length (AL)≥26.5 mm] and MHRD who underwent PSC combined with intravitreal C₃F₈ injection, with at least 6mo of follow-up were retrospectively recruited. Outcome measures included best-corrected visual acuity (BCVA), AL, optical coherence tomography (OCT) findings, and adverse events. Retinal recovery was categorized as type I (macular hole bridging with retinal reattachment) or type II (reattachment without hole bridging).

Results: The mean age of participants was 62.1±8.8y and mean follow-up duration was 9.18±4.21mo. Complete retinal reattachment was observed in 11 eyes (50%) at postoperative day 1, 19 eyes (86.3%) at week 1, and all 22 eyes at month 1. Ten eyes (45.5%) achieved type I recovery and 12 eyes (54.5%) achieved type II. Mean BCVA improved from 1.68±0.84 logMAR before surgery to 1.21±0.65 logMAR after surgery (P<0.001), and AL was significantly reduced compared to baseline (29.07±2.05 vs 30.8±2.2 mm; P<0.001). No serious complications were reported.

Conclusion: PSC combined with intravitreal C₃F₈ injection is a safe and effective treatment for MHRD in highly myopic eyes, especially for retinal detachment limited within the vascular arcade.

Keywords: C3F8; macular hole; myopia; posterior scleral contraction; retinal detachment.

Figure 1. Representative case 1 with the longest follow-up time-24mo

Preoperatively, optical coherence tomography (OCT; A1) showed a macular hole with retinal detachment, widefield fundus photography (A2) reveals a grayish elevation of the retina in the temporal, inferior, and inferonasal regions, and B-scan ultrasound (A3) confirms the detachment. On postoperative day 1, the retina appears essentially reattached on OCT, although the macular hole remains unclosed (B1), and widefield fundus photography (B2) showed a flattened retina with a visible perfluoropropane (C₃F₈) gas bubble. At 1wk postoperatively, OCT still indicates an unclosed macular hole despite retinal reattachment (C1), widefield imaging shows a reduced gas bubble and a flattened retina (C2), and B-scan ultrasound confirms the flattened retina (C3). By 1mo, OCT demonstrates a reattached retina with a closed macular hole (D1), corroborated by widefield imaging (D2). At 24mo, OCT confirms stable retinal reattachment and macular hole closure (E1), widefield imaging shows the retina remains flat (E2), and B-scan ultrasound verifies persistent retinal flattening (E3).

Figure 2. Representative case 2

Preoperatively, optical coherence tomography (OCT; A1) showed a macular hole with retinal detachment, widefield fundus photography (A2) reveals a grayish retinal elevation within the vascular arcade, and B-scan ultrasound (A3) confirms partial retinal detachment. On postoperative day 1, OCT (B1) indicated a reduced extent and height of the detachment, and widefield imaging (B2) shows a large perfluoropropane (C₃F₈) gas bubble with less pronounced retinal elevation. By postoperative day 3, OCT (B3) confirmed that the retina has reattached. At 1wk, OCT (C1) still showed an unclosed macular hole despite retinal reattachment, while widefield imaging (C2) demonstrated a smaller gas bubble and a flattened retina within the vascular arcade; B-scan ultrasound (C3) corroborated these findings. At 1mo, OCT (D1) showed a reattached retina with type II macular hole closure; widefield imaging (D2) and B-scan ultrasound (D3) further confirm retinal flattening. By 6mo, OCT (E1) indicated stable reattachment with persistent type II hole closure, and widefield imaging (E2) and B-scan ultrasound (E3) both show a flat retina.