COMPLETE EPIRETINAL MEMBRANE SEPARATION IN HIGHLY MYOPIC EYES WITH RETINAL-DETACHMENT RESULTING FROM A MACULAR HOLE

PURPOSE: Epiretinal membranes (ERMs) in highly myopic eyes may result in macular holes and subsequent retinal detachment, However, removing friable, thin ERMs from detached retinas is often difficult. We report the efficacy of a diamond-dusted silicone cannula in the removal of E RMs from detached retinas. METHODS: Seventeen consecutive highly myopi c eyes (16 patients) with retinal detachment underwent pars plana vitr ectomy with gas tamponade. Peeling of the ERM adjacent to the macular hole was performed using either conventional tools (n = 11) or a diamo nd-dusted silicone cannula (n = 6). The rate of complete membrane peel ing and the effect of membrane removal on the anatomic success rate we re compared between groups. RESULTS: Retinal reattachment occurred in 13 (92.9%) of the 14 eyes in which the ERM was removed completely; red etachment occurred in the other three eyes, with further surgical inte rventions in two eyes. The reattachment rate was significantly higher (P =.005) when ERM removal was complete than when there was residual E RM. In the initial surgery, the ERM was success fully removed in all 6 eyes (100%) in the diamond-dusted silicone cannula group and in 5 of 11 eyes (45.5%) in the conventional group (P =.041); the reattachment rate was 100% in the diamond-dusted silicone cannula group and 45.5% i n the conventional group (P =.005). When a second surgery was performe d, the use of the diamond-dusted silicone cannula was also better than conventional tools for removing the residual ERMs, resulting in retin al reattachment. CONCLUSION: In highly myopic eyes with a macular hole and subsequent retinal detachment, complete ERM removal is closely re lated to successful retinal reattachment. The diamond-dusted silicone cannula appears to be more effective than conventional tools for remov ing ERM and may increase the anatomic success rate. Because of the lim itations of a small series, a prospective, randomized trial is require d to confirm the current beneficial results of using a diamond-dusted silicone cannula. (Am J Ophthalmol 1998;126: 669-676. (C) 1998 by Else vier Science Inc. All rights reserved.).