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  • Title: Vitrectomy with Internal Limiting Membrane Repositioning and Autologous Blood for Macular Hole Retinal Detachment in Highly Myopic Eyes.
    Author: Lai CC, Chen YP, Wang NK, Chuang LH, Liu L, Chen KJ, Hwang YS, Wu WC, Chen TL.
    Journal: Ophthalmology; 2015 Sep; 122(9):1889-98. PubMed ID: 26143541.
    Abstract:
    PURPOSE: To investigate the surgical results of macular hole retinal detachment (MHRD) repaired using vitrectomy combined with inverted internal limiting membrane repositioning (ILMR) and autologous blood clot (ABC) in highly myopic eyes. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Twenty-seven cases of MHRD. METHODS: Twenty-seven cases of highly myopic eyes with MHRD in 27 patients who underwent a vitrectomy combined with ILMR and ABC and were followed up over 6 months were reviewed. The anatomic outcomes of MHRD were evaluated by fundus examinations and optical coherence tomography. The preoperative and postoperative best-corrected visual acuities (BCVAs) were compared as the functional outcome. MAIN OUTCOME MEASURES: Retinal reattachment, macular hole (MH) closure, and BCVA before and after surgery. RESULTS: In total, women accounted for 85% (23/27) of the MHRD patients. The mean age was 59.1±10.6 years. The mean axial length was 29.37±1.92 mm. Type 1 MHRD was present in 9 eyes, and type 2 MHRD was present in 18 eyes. After a single surgery, the retina was attached and the hole was closed in 26 eyes (96%), and 100% retinal attachment was achieved by another vitrectomy for rhegmatogenous retinal detachment that occurred 3 months after the initial surgery. A parafoveal unclosed hole was found in 1 eye (4%) during the follow-up period, and the patient did not undergo further treatment. Three eyes with a closed hole showed persistent subretinal fluid (SRF) after gas absorption. In 2 of these cases, the fluid absorbed completely during the follow-up period, but 1 eye exhibited persistent SRF, which was resolved progressively during the 12 months of follow-up. The surgery significantly improved the BCVAs {from 1.8±0.7 logarithm of the minimum angle of resolution units to 1.3±0.7 logarithm of the minimum angle of resolution units (P = 0.001)} at 3 and 6 months and at the last visit after surgery. Seven patients underwent cataract surgery during the follow-up period. CONCLUSIONS: A vitrectomy combined with ILMR and ABC is effective for closing MHs and reattaching the retina and significantly improves the postoperative BCVA in MHRD patients.
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