Vitreo-retinal relationship and post-operative outcome of macular hole repair in eyes with high myopia

Purpose To investigate the vitreoretinal relationship in eyes with full-thickness macular hole (FTMH) without retinal schisis or detachment. Eyes with and without high myopia were compared using slit-lamp biomicroscopy, optical coherence tomography (OCT), and intraoperative observations. Methods Clinical records of 34 consecutive cases of FTMH without schisis or detachment in highly myopic eyes (refractive error larger than -6.0 diopters or axial length >26 mm) were retrospectively reviewed. All eyes underwent pars plana vitrectomy between 2006 and 2013. An additional 43 consecutive cases of FTMH in eyes without high myopia were also reviewed to serve as controls. All control patients underwent surgery during the same period. Ophthalmological, OCT, and intraoperative findings, and vitreoretinal interface features were documented in both groups. Anatomical closure rate and final best-corrected visual acuity (BCVA) were compared between groups. Results Premacular tissue was identified during surgery in 21 of 34 high myopia patients (61.8 %) and three of 43 control patients (7.0 %). The high myopia group showed two layers of premacular membranes. Two cases had a shiny, loose inner membrane, 13 cases had a tightly adherent outer membrane, and six cases had both. Only a tightly adherent membrane was found in controls. In the high myopia group, 11 of 21 eyes (52.4 %) did not have a preretinal membrane identified pre-operatively. Anatomical closure was achieved in 91.2 and 95.3 % of high myopia and control patients respectively (p=0.65). No significant intergroup difference in final BCVA was observed. Conclusion Premacular tissue was found in 61.8 % of eyes with high myopia and FTMH without retinal schisis or detachment. Anatomically successful surgical closure in high myopia patients was achieved at a rate comparable to their idiopathic counterparts.