The role of vitreoretinal surgery in the management of myopic macular holewithout retinal detachment

Purpose: To evaluate the anatomic and functional outcome of vitreoretinal s urgery in eyes with pathologic myopia and macular hole and to determine if surgery improves visual acuity. Methods: Twenty-four consecutive highly myopic eyes with full-thickness mac ular hole without posterior retinal detachment were treated by vitrectomy. Posterior hyaloid dissection, removal of epiretinal and internal limiting m embranes (ILM) if thickened, instillation of platelet concentrate, and flus hing with 25% sulfur hexafluoride were performed. Results: Patients' refrac tive error ranged between -8.0 and -17.5 diopters, and axial length ranged from 27.1 to 31.4 mm. Two epimacular membranes and 10 macular ILM were remo ved. Ten patients also underwent phacoemulsification and intraocular lens i mplantation at the same procedure. Mean preoperative best-corrected visual acuity was 20/200. Successful anatomic macular hole closure occurred 6 mont hs postoperatively in 100% of eyes after one (21 eyes, 87.5%) or two surger ies (3 eyes, 12.5%). Visual acuity improved three or more lines in 83.3% of patients. Mean postoperative visual acuity was 20/70. No retinal detachmen t was observed during the follow-up period, which ranged from 12 to 45 mont hs. Conclusion: Our results suggest that vitreoretinal surgery may effectively manage myopic macular holes, thus improving anatomic and visual outcomes. B y closing the hole, vitreoretinal surgery may decrease the risk of posterio r retinal detachment in highly myopic eyes.