A clinical evaluation of combination of vitrectomy and heavy silicone oil tamponade for retinal detachment with macular hole in high myopic eye

Background The surgery for retinal detachment induced by macular hole in high myopic eye has a lower success rate in comparison with other rhegmatogenous retinal detachment.A combination procedure of vitrectomy and heavy silicone oil tamponade for retinal detachment induced by macular hole in high myopic eye has been used,but different outcomes are reported. Objective This study was to assess the efficacy of heavy silicone oil tamponade for the treatment of retinal detachment with macular hole in high myopic eye. Methods The clinical data of 20 eyes of 20 patients who received vitrectomy combined heavy silicone oil tamponade surgery for retinal detachment induced by macular hole in high myopia under the informed consent in Beijing Tongren Eye Center from September 2007 to December 2009 were retrospectively analyzed.The 20 G vitrectomy was used during the surgery.In addition,other procedures,such as epiretinal membrane peeling,retinotomy,endo-laser photocoagulation,phacoemulsification and intraocular lens(IOL) implantation were optionally performed as necessary.No special position was required after the surgery.Heavy silicon oil was removed via pars plana,and retinal reattachment after heavy silicon oil removal was defined as success of surgery.Postoperative LogMAR vision,intraocular pressure,retinal reattachment and complications were observed and evaluated. Results The preoperative average spherical equivalent refractive error was (-14.3±3.0) D in the eyes.Among the 20 eyes,there were 7(35%) recurrent retinal detachment and 7 eyes (35%) complicated with choroidal detachment preoperatively.After surgery,the retinas were reattached in 95% eyes (19/20),including retinal reattachment after first operation in 18 eyes (90%) and after second surgery in 1 eye (5%).A localized retinal detachment was still existed after a second surgery in the other 1 eye.The mean LogMAR vision improved from preoperative 2.77±0.81 to postoperative 1.22±0.46 (P=0.000).All the phakic eyes developed different degrees of sub-capsular cataract.Long-term ocular hypertension was found in 2 eyes after surgery. Conclusions The combination of vitrectomy and heavy silicone oil endotamponade is a safe and effective approach to retinal detachment with macular hole in high myopic patients. This procedure may improve vision and offers comfortable position after surgery for the patients. Key words: Retinal detachment; High myopia; Densiron 68; Vitrectomy; Macular hole