Surgical management of retinal detachment because of macular hole in highly myopic eyes

Purpose: The purpose of this study was to review the current management of macular hole retinal detachment in highly myopic eyes. Methods: We searched English MEDLINE databases from January 1997 to January 2011 for surgical management of macular hole retinal detachment in highly myopic eyes. The main outcomes reported include retinal reattachment and visual acuity after primary surgery. Results: Surgical procedures including pneumoretinopexy, pars plana vitrectomy with gas or silicone oil tamponade with or without laser therapy around the macular hole, and macular buckling have been the primary treatment choices. New techniques, including internal limiting membrane or epiretinal membrane peeling and heavy silicone oil tamponade, have been introduced over the last decade, and use of optical coherence tomography has allowed evaluation of the postoperative anatomical status of holes undetectable by conventional ophthalmoscope or lens biomicroscope. Poor functional and anatomical outcomes and nonclosure or reopening of a macular hole are still crucial problems, and some patients may require multiple procedures. Conclusion: Macular hole retinal detachment in highly myopic eyes is one of the most difficult types of retinal detachment to treat, and its primary treatment choice is still controversial, although the different surgical techniques reported in this review have been demonstrated as good surgical options. Randomized clinical trials are largely lacking