Comparative study on the clinical effect of 23G versus 20G vitrectomy combined with internal limiting membrane peeling and silicone oil tamponade for macular hole retinal detachment in highly myopic eyes

Objective To compare the effect of 23G vitrectomy and 20G vitrectomy combined with intemal limiting membrane (IML) peeling and silicone oil tamponade for macular hole retinal detachment (MHRD) in highly myopia eyes.Methods A retrospective case series study.Thirty-nine patients (39 eyes) with macular hole retinal detachment (MHRD)in highly myopic eyes underwent either 23G (20 eyes,23G group) or 20G vitectomy (19 eyes,20G group) combined with internal IML and silicone tamponade.Preoperatively,all the patients had A/B-ultrasonography,intraocular pressure,best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations.Postoperatively,intraocular pressure,BCVA,the rate of the macular hole closure and retinal reattachment were observed.The BCVA was converted to logarithm of the minimal angle of resolution (logMAR)and analyzed.Results The mean preoperative and postoperative BCVA in 23G group were logMAR2.19±0.14 and logMAR1.33±0.55.The difference between preoperative and postoperative logMAR BCVA was significant (Z =-3.728,P =0.000＜0.05).The mean preoperative and postoperative BCVA in 20G group were logMAR 2.05±0.35 and logMAR1.74±0.44.The difference between preoperative and postoperative logMAR BCVA was significant (Z =-2.887,P =0.004＜0.05).The difference between postoperative logMAR BCVA in two groups was significant (U =108.5,P =0.021＜0.05).Seven (35％) cases of low intraocular pressure (IOP) after surgery were found in 23G group.The mean IOP at day 1 after surgery was 9.62±4.03mmHg.Comparing with preoperative IOP,the difference was significant (t =2.747,P =0.013＜0.05).Two (10.52％) cases of low intraocular pressure (IOP) after surgery were found in 20G group.The mean IOP at day 1 after surgery was 1 1.79±6.9mmHg.Comparing with preoperative IOP,the difference was not significant (t =-0.432,P =0.671＞0.05).The difference of the mean IOP at day 1 after surgery between two groups was significant (t =2.118,P =0.041＜0.05).The final OCT showed seven eyes (35％) in 23 G group were found macular hole closure and four eyes (26.3％) in 20G group.The reattachment rate in final visit of 23G and 20G were 100％ and 94.7％.Conclusions There is a high retinal reattachment rate and a significant improvement without many complications in VA in MHRD patients for 23-gauge vitrectomy with IML peeling and silicone oil tamponade.The macular hole closure rate of two groups is low. Key words: Vitrectomy;  High myopia;  Retinal detachment;  Macular hole