2/16/2024 0 Comments Hole in retina without detachment![]() The aim of this study is to gain an understanding of the UK practice patterns for the management of MHRD and MRS in PM. While macular buckling for MHRD was originally developed to treat the posterior staphyloma, further interest in this technique has increased during the last 10–15 years, at least in part because of the limited success rates with vitrectomy alone. Traditionally, the management in the UK has involved PPV, epiretinal membrane (ERM)/ ILM peel with gas or oil tamponade. Pars plana vitrectomy (PPV), encircling scleral buckle, peeling of internal limiting membrane (ILM)/pre-retinal membranes, various intraocular tamponade agents and macular buckle have all been used with variable success rates. The treatment criteria and management of MHRD and MRS also remain controversial. It would, therefore, appear that both intraocular and outer ocular wall factors can impact on the natural progression to MHRD and the outcome of treatment strategies. MRS in PM is now considered a progressive condition leading to macular hole and secondary retinal detachment when myopic traction maculopathy is present, with high rates of progression in cases of extensive MRS. High resolution optical coherence topography (OCT) provides a detailed examination of the retinal structure and allows the distinction between macular detachment and retinoschisis. This may be associated with progressive stretching and thinning of the retina because of the disparity between the retina and the sclera, which could precipitate the development of retinal detachment or retinoschisis. With increasing age, the incidence and size of the staphyloma increase. also found that retinal detachment and MRS were common features in high myopes with staphyloma, but postulated that retinal detachment may precede macular hole formation. were the first to report the role of staphyloma in contributing to retinal detachment in the presence of macular hole rather than anterio-posterior vitreomacular traction. While the exact pathogenesis of MHRD is unknown, many hypotheses have been suggested including anterior–posterior vitreoretinal tractional forces, posterior staphyloma and large areas of chorioretinal atrophy leading to weak adhesion between the retina and the underlying retinal pigment epithelium (RPE). Īmongst the spectrum of complications associated with PM, macular hole with secondary retinal detachment (MHRD) and macular retinoschisis (MRS) have been difficult to manage. The definition of PM has been recently updated and is defined as eyes with characteristic myopic fundal findings and a refractive error of ≥−8 Dioptres. The estimated prevalence in the USA, Western Europe and Australia is 2.8–4.6%. Prevalence estimates have been difficult to ascertain due to varying study definitions and differences between populations. Pathological myopia (PM) is a common cause of vision loss worldwide and the global prevalence appears to be increasing, particularly in Asian populations. Success rates and visual outcomes are limited for MHRD and consistent with the current literature for MRS. PPV is the only surgical procedure performed for the management of MHRD and MRS amongst the study participants. Anatomical outcomes demonstrated a persistent MRS in 2/27 (7.4%) cases, partial resolution in 7/27 (25.9%) cases and complete resolution in 16/27 (59.2%) cases. Mean post-operative BCVA was 0.68 logMAR ( p = 0.183). All eyes that had surgical intervention underwent PPV. MRS: Mean baseline BCVA was 0.87 logMAR in the surgical group and 0.45 logMAR in the conservatively managed group ( p = 0.002). The macular hole was closed in 5/20 (25%) cases, open/flat in 10/20 (50%) cases and open/elevated in 4/20 cases (20%). Mean post-operative BCVA was 1.49 logMAR ( p = 0.674). All cases underwent pars plana vitrectomy (PPV). MHRD: Mean baseline best corrected visual acuity (BCVA) was 1.60 logMAR. A total of 20 cases of MHRD and 53 cases of MRS (27 surgical cases and 26 cases managed conservatively) are reported in this combined study. ![]() The results were combined with retrospective data, collected by the COllaboration of British RetinAl Surgeons (COBRA), on the management of both MHRD and MRS in PM in the UK. MethodsĪ prospective observational case series for the management of MHRD was undertaken in association with the British Ophthalmological Surveillance Unit (BOSU). To review the anatomical and visual outcomes of the surgically managed cases. To study UK practice patterns for the management of retinal detachment secondary to macular hole (MHRD) and macular retinoschisis (MRS) in pathological myopia (PM).
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