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| EDITORIAL |
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| Year : 2013 | Volume
: 3
| Issue : 4 | Page : 127 |
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Editorial
| Date of Web Publication | 20-Nov-2013 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
DOI: 10.1016/j.tjo.2013.10.003
How to cite this article:
. Editorial. Taiwan J Ophthalmol 2013;3:127 |
High myopia has a high prevalence in Taiwan.[1] Macular hole is one of the frequently seen complications of myopic maculopathy. The formation of macular hole in high myopia involves complex traction forces from various directions. At least six traction forces may contribute to the development of macular hole in high myopia. These include the following: Vitreous anterior-posterior traction, oblique or tangential traction from partially or undetached posterior hyaloid, traction from epiretinal membrane, internal limiting membrane induced tangential traction, posterior outward traction from the staphyloma, and retinal vessels traction.[2],[3],[4] These factors, alone or in combination, may induce macular hole formation through mechanisms either similar to those underlying idiopathic macular hole or unique to high myopic condition. Idiopathic macular hole rarely cause macular detachment. Persistent and multidirectional traction after the development of macular hole plus the abnormal retinal pigment epithelium (RPE) function from chorioretinal atrophy would predispose high myopic eyes with macular hole to localized or extensive retinal detachment (RD). The extent of RD varies, and the best treatment remains controversial. Treatment options range from intravitreal gas injection to vitrectomy with or without internal limiting membrane peeling to macular buckling. For uncomplicated RD, long-acting gas injection alone is able to achieve about 55% of reattachment rate, compared with 80% obtained by vitrectomy.[5] Removing the preretinal traction as completely as possible is the key for surgical reattachment. However, even with vitrectomy and membrane peeling, the hole closure rate is disappointing, hovering around 10–30%. With localized RD (RD extension limited within the equator), a single or repeated gas injection may have a reattachment rate of 70% after 1 year, with persistent open hole in most treated eyes.[6] Unfortunately, the high-success reattachment rate is not maintained during a longer period of follow-up, particularly in those with optical coherence tomography (OCT)-detectable premacular traction. Several studies have shown that macular buckling may achieve a high reattachment rate and a high hole closure rate. However, the long-term effects from the eye wall distortion and compression by the buckle remain a major concern. As in other rhegmatogenous RD, RD secondary to macular hole may develop proliferative vitre-oretinopathy (PVR) if left untreated. In a pseudophakic eye, RD tends to progress rapidly, which may induce severe hypotony, leading to ciliochoroidal detachment. PVR becomes common under this scenario. Persistent or recurrent detachment after primary vitrectomy also tends to develop PVR. Clinical studies specifically focusing on PVR associated with macular hole in high myopia have been rare in the literature. In this issue, San-Ni Chen and associates reported the clinical presentations and surgical results of macular hole with PVR changes in high myopia. The results showed that with meticulous membrane dissection, high anatomical success may be obtained. However, as up to 75% of cases require long-term silicone oil tamponade and the hole closure rate is low, the treated eyes run the risk of recurrent RD when complications related to silicone oil prompt its removal. The treatment of RD secondary to macular hole in high myopia continues to be a major challenge to the vitreoretinal surgeons.
| References | |  |
| 1. | Shih Yung-Feng, Chiang Ting-Hsuan, Hsiao C Kate, Chen Chien-Jen, Hung Por-Tying, Lin Luke L-K. Comparing myopic progression ofurban and rural Taiwanese schoolchildren. Jpn JOphthalmol 2010; 54:446–51.  |
| 2. | Smiddy WE, Kim SS, Lujan BJ, Gregori G. Myopic traction maculopathy: spectral domain optical coherence tomographic imaging and a hypothesized mechanism. Ophthalmic Surg Lasers Imaging 2009; 40:169–73. |
| 3. | Oshima Y, Ikuno Y, Motokura M, Nakae K, Tano Y. Complete epiretinal membrane separation in highly myopic eyes with retinal detachment resulting from a mac-ular hole. Am J Ophthalmol 1998; 126:669–76. |
| 4. | Sayanagi K, Oshima Y, Ikuno Y, Tano Y. Presumed vascular traction-associated recurrence of retinal detachment in patients with myopic macular hole. Ophthalmic Surg Lasers Imaging 2009; 40:60–4. |
| 5. | Li X, Wang W, Tang S, Zhao J. Gas injection versus vitrectomy with gas for treating retinal detachment owing to macular hole in high myopes. Ophthalmology 2009; 116:1182.e1–1187.e1. |
| 6. | Chen FT, Yeh PT, Lin CP, Chen MS, Yang CH, Yang CM Intravitreal gas injection for macular hole with localized retinal detachment in highly myopic patients. Acta Ophthalmol 2011; 89:172–8. |
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