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Effectiveness of combined macular buckle under direct vision and vitrectomy with ILM peeling in refractory macular hole retinal detachment with extreme high axial myopia: a 24-month comparative study
  1. Jin Ma,
  2. Honghui Li,
  3. Xiaohu Ding,
  4. Silvia Tanumiharjo,
  5. Lin Lu
  1. Zhongshan Ophthalmic Center, Sun Yat-sen University, State Key Laboratory of Ophthalmology, Guangzhou, People's Republic of China
  1. Correspondence to Professor Lin Lu, Zhongshan Ophthalmic Center, Sun Yat-sen University, State Key Laboratory of Ophthalmology, 510060, No. 54 Xianlie road, Guangzhou, 510060, People's Republic of China; drlulin{at}126.com

Abstract

Purpose To evaluate the efficacy of a combined macular buckle under direct vision and 23-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in refractory macular hole retinal detachment (MHRD) with extreme high axial myopia.

Design Prospective, randomised controlled study.

Participants The study included 98 eyes of 98 patients of MHRD with extreme high axial (>30 mm) myopia.

Intervention Patients were randomly assigned to undergo PPV with ILM peeling (group 1, n=52) or PPV with ILM peeling combined with macular buckle under direct vision (group 2, n=46).

Main outcome measures Complete ocular examination included best-corrected visual acuity (BCVA) (LogMAR), applanation tonometry, optical biometry, slit-lamp biomicroscopy, colour fundus photography, ultrasound examination and optical coherence tomography at baseline and every follow-up visit.

Results Initial retinal reattachment rate was significantly higher in group 2 than in group 1 at 12-month postoperatively (χ2 test, p=0.020). Macular hole closure rate in group 2 was significantly higher than that in group 1 at 3, 12, 18 and 24 months postoperatively (Fisher's exact test, p<0.05). In initial retinal reattachment cases, the mean BCVA decreased significantly in group 2 than in group 1 at 3 months postoperatively (Wilcoxon matched pairs signed rank test, p=0.036), and had increased significantly in group 2 than in group 1 since 6 months postoperatively (Wilcoxon matched pairs signed rank test, p<0.05). Mean axial lengths in group 2 were significantly shorter than that of group 1 at each follow-up time point (Wilcoxon matched pairs signed rank test, p<0.05).

Conclusions Combined macular buckle under direct vision and PPV with ILM peeling is more effective in treatment of MHRD with extreme high axial (>30 mm) myopia.

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Footnotes

  • Contributors LL conceived and designed the study; JM was operator in this study, and drafted this article; HL, XD and ST collected, analysed and interpreted the clinical data and revised the manuscript.

  • Funding This work was supported by the National Natural Science Foundation of Guangdong, China (grant number 2016A030313364) and the Science and Technology Program of Guangzhou, China (grant number 2016070010070).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The institutional ethics committee of Zhongshan Ophthalmic Center, Sun Yat-Sen University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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