Scleral imbrication shows promise in second surgery for refractory MHRD

By Lucy Piper, Senior medwireNews Reporter

Combining vitrectomy and gas tamponade with sclera imbrication results in high retinal reattachment and macular hole closure rates among patients with refractory macular hole retinal detachment (MHRD) associated with high myopia, study findings indicate.

Researcher Masato Fujikawa (Shiga University of Medical Science, Otsu, Japan) and colleagues reviewed the post-surgery effects of adding sclera imbrication on the eyes of eight patients with MHRD and high myopia.

The patients underwent sclera imbrications combined with pars plana vitrectomy (PPV) and gas tamponade as a second surgery, in most cases due to redetachment after primary PPV with gas tamponade.

Over an average follow-up of 889 days, vision improved in all the eyes and optical coherence tomography confirmed retinal reattachment in all eyes and macular hole closure in six (75%).

The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved significantly, from 1.43 at baseline to 0.87 at the final visit.

The surgery resulted in shortening of axial length in all six eyes for which pre- and postoperative measures were available, from an average of 29.5 mm before sclera imbrication to 27.1 mm 1 month afterwards, reflecting a 9.6% decrease. It lengthened slightly with time, to 28.1 mm at the final visit, but still remained significantly shorter compared with baseline.

At the final visit, eight of the eyes had regular Keratometric astigmatism, while six had against-the-rule astigmatism, but the researchers report that the average 1-month surgically induced astigmatism of 3.6 diopters decreased significantly to 2.4 diopters at the final assessment. They note in Retina that the surgically induced astigmatism did not correlate with the rebound in axial length between 1 month post surgery and the final visit.

“The current data supported the contention that the sclera imbrication combined with PPV and gas tamponade produced shortening of axial length and flattening of the posterior eye wall including the posterior staphyloma, thus both shortening and flattening may facilitate the retinal reattachment and the closure of [macular holes]”, say Fujikawa et al.

They suggest that, for some patients, vitrectomy with internal limiting membrane peeling and gas tamponade may be sufficient to treat MHRD, but for refractory cases sclera imbrications should be considered.

“Our observations should be confirmed by further investigation because this study was retrospective with a small number of cases”, the team concludes.

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