Cai Yi , Zhao Mingwei , Liang Jianhong , Yin Hong , Yu Wenzhen , Shi Xuan , Qu Jinfeng , Cheng Yong , Hou Jing , Miao Heng , Jin Enzhong
  • Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China;
Jin Enzhong, Email: jinenzhong@pku.edu.cn
Macular hole retinal detachment; Choroidal detachment; Highly myopic; Pars plana vitrectomy; Prognosis
10.3760/cma.j.cn511434-20241008-00369
Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables References Cited by

Objective To observe the clinical features of the patients with high macular hole retinal detachment (MHRD) complicated with choroidal detachment, and to analyze the related factors affecting the closure of the hiatus after surgery. Methods A retrospective clinical case series study. A total of 68 patients with high myopia and 68 eyes with MHRD diagnosed by Department of Ophthalmology, Peking University People’s Hospital from January 2019 to April 2024 were included in this study. Among them, 14 males had 14 eyes and 54 females had 54 eyes. The mean age was (61.1±9.66) years. All eyes were treated with pars plana vitrectomy (PPV) combined with silicone oil or gas filling. Best corrected visual acuity (BCVA), intraocular pressure, and B-mode ultrasonography were performed. The BCVA test was performed using the Snellen visual acuity chart, which was statistically converted to logMAR visual acuity. The range of choroidal detachment was defined according to the number of involved quadrants observed in B-mode ultrasound or surgery, which was divided into 1 to 4 quadrants. Axial length (AL) was measured with the retina repositioned and filled with silicone oil. In 68 eyes, there were 17 cases with choroidal detachment and 51 eyes without choroidal detachment, respectively. There were 17 eyes with choroidal detachment, and the detachment range involved 1, 2, 2 and 12 eyes in 1, 2, 3 and 4 quadrants, respectively. During operation, 13% C3F8 was filled in 2 eyes, all of which were not complicated with choroidal detachment. 66 eyes were filled with silicone oil. According to whether the patients were complicated with choroidal detachment, the patients were divided into the group without choroidal detachment and the group with choroidal detachment. Independent sample t test, Welch two-sample t test or Mann-Whitney U test were used for comparison between groups. Generalized linear regression and logistic regression were used to analyze the relationship between the open hole aperture and the closed hole after surgery and clinical factors. Results At 3 months after surgery, the logMAR BCVA of the affected eye was 1.29±0.43, with a preoperative to postoperative difference ranging from −1.60 to 0.700 (−0.51±0.51) logMAR units. The AL ranged from 26.6 to 34.3 (29.6±2.12) mm. Among 68 eyes, 37 (54.4%, 37/68) eyes were open and 31 (45.6%, 31/68) eyes were closed, respectively. The hole diameter of the open eye was (753±424) µm. There was no significant difference in age, course of disease and AL between the two groups (W=412.0, 477.5, 427.0; P＞0.05). Before operation, BCVA in patients with choroidal detachment was worse (W=257.5) and IOP was lower (t=4.051) in patients with choroidal detachment compared with those without choroidal detachment, with statistical significance (P＜0.05). At 3 months after surgery, BCVA in patients with choroidal detachment was significantly worse than that in patients without choroidal detachment, with statistical significance (W=284.0, P＜0.05). There were no significant differences in logMAR BCVA difference (t=0.616) and hiatus closure rate (χ2=0.000) before and after surgery (P＞0.05). The reoperation rate of retinal detachment due to non-reduction or recurrence was significantly higher in the group with choroid detachment than in the group without choroid detachment, and the difference was statistically significant (odds ratio=6.424, P＜0.05). logistic regression analysis showed that age was significantly correlated with hiatus failure after surgery (β=0.077, P=0.015). There was no correlation between AL, duration of disease, BCVA before surgery, intraocular pressure, choroid detachment range and postoperative hole closure (β=−0.072, 0.000, 0.672, −0.085, −0.391; P＞0.05). Conclusions Concomitant choroidal detachment had adverse effects on both pre-operative and post-operative visual acuity recovery of high myopia MHRD, and was closely related to the risk of recurrent retinal detachment and multiple operations, but had no significant effect on hole closure rate. Lower age of onset may be a risk factor for hiatus closure.

Copyright © the editorial department of Chinese Journal of Ocular Fundus Diseases of West China Medical Publisher. All rights reserved