Long-term follow-up of primary silicone oil tamponade for retinal detachment secondary to macular hole in highly myopic eyes: a prognostic factor analysis

Abstract

Purpose: To investigate the risk factors associated with retinal detachment recurrence after first vitrectomy in high myopic eyes with macular hole retinal detachment (MHRD).

Methods: Patients with high myopic eyes with MHRD who underwent pars plana vitrectomy and silicone oil (SO) tamponade with a follow-up period more than 12 months and more than 3 months after SO removal were included in this retrospective study. Logistic regression was performed to determine the risk factors associated with retinal re-detachment.

Results: A total of 45 eyes from 43 patients were included in this study (11 male and 34 female patients). The retinal re-detachment rate after the first removal of silicon oil was 35.5% (16/45) in a mean postoperative follow-up time of 35.64 ± 32.94 months. Complete macular atrophy on fundus photography (odds ratio (OR) = 17.021, 95% confidence interval (95% CI): 2.218-130.609, p = 0.006) was a risk factor for MHRD after SO removal, while internal limiting membrane (ILM) peeling (OR = 0.091, 95% CI: 0.013-0.633, p = 0.015) and duration of SO tamponade (OR = 0.667, 95% CI: 0.454-0.980, p = 0.039) were protective factors.

Conclusion: For high myopic eyes with MHRD, complete macular atrophy was a significant risk factor for retinal re-detachment after silicon oil removal. ILM peeling and the duration of silicon oil tamponade were protective factors.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1. Representative images to illustrate the macular atrophy on the fundus photography and OCT.

a Diffuse chorioretinal atrophy (A2) appears yellowish-white at the posterior pole. b Patchy chorioretinal atrophy (A3) appears as well-defined, greyish-white lesions that are not centred on the fovea and have irregular margins. This image shows the unclosed macular hole after vitrectomy and the atrophic spot that is right next to the macular hole. c The eye has complete macular atrophy (A4) combined with staphyloma and severe posterior pole choroidal atrophy. d OCT shows the remaining choroidal vasculature under the central fovea. e Complete choroidal atrophy defined as a full-thickness defect of the choroidal vasculature within the central macula on OCT.

Fig. 2. The clinical events of all patients in a visual manner.

Figure a displays the timeline of recurrence and re-operation in all patients since the first surgery and the length of the entire follow-up. Figure b is arranged in the order of events, with no timeline displayed. All patients underwent silicone oil removal. Sixteen of 45 eyes developed retinal re-detachment, and the patients opted for second surgical interventions. A total of 37.5% of cases of re-detachment (six eyes) developed after 1 year. Four eyes still had SO tamponade at the end of the follow-up. One eye had retinal detachment without SO tamponade at the last follow-up. The final retinal reattachment rate was 97.8% (44/45).