Evaluation of Primary Surgical Procedures for Retinal Detachment with Macular Hole in Highly Myopic Eyes A Randomized Comparison of Vitrectomy versus Posterior Episcleral Buckling Surgery

Purpose: To evaluate postoperative outcomes between pars plana vitrectomy (PPV) and posterior episcleral buckle procedure (PEBP) in myopic eyes with retinal detachment (RD) and macular hole (MH). Design: Retrospective nonrandomized comparative interventional trial. Participants and Intervention: The study included 30 phakic, highly myopic eyes (from 19–30 negative diopters) of 30 patients with an RD and MH. The patients were divided into two groups: They were assigned to PPV (15 eyes, group A) or to PEBP (15 eyes, group B). No significant (P 0.01) differences in preoperative visual acuity (VA) between group A and group B eyes were found. Follow-up was 12 months. Main Outcome Measures: Anatomic attachment of the retina was determined, and VA was measured. Results: Retinal reattachment was obtained on 11 of 15 (73.3%) eyes of group A and on 14 of 15 (93.3%) eyes of group B. In group A eyes the VA was substantially unmodified after surgical treatment, whereas in group B eyes the VA observed after surgical treatment increased significantly (P 0.001) with respect to the preoperative values. Conclusions: PEBP resulted in better postoperative anatomic and functional results compared with PPV in eyes with extreme degrees of myopia, pronounced posterior staphyloma, and posterior vitreous schisis affected with RD caused by MH. Ophthalmology 2001;108:2258–2265 © 2001 by the American Academy of Ophthalmology.