Outcomes of surgical treatment for retinal detachment in highly myopic eyes with macular hole

To determine the type and outcome of surgery for retinal detachment resulting from macular hole in highly myopic eyes. This retrospective analysis was performed on the medical records of highly myopic patients who underwent surgery for retinal detachment [RD] resulting from macular hole at Labbafinejad Hospital, Tehran-Iran from 1992 to 2001. Variables included age, gender number and type of operations, visual acuity before and after the procedures and surgical success rate. Overall, 28 eyes of 27 patients [26 female and one male] with mean age of 59.8 +/- 11 years were included. Main follow-up was 17.3 [range 3-72] months. Mean axial length was 29 +/- 2.74mm [range: 24 to 35mm] and mean degree of myopia was -16.4 +/- 3.1 D [range -10 to -22 D]. Posterior staphyloma was present in 20 eyes [71%]. Seven eyes had undergone failed scleral buckling as the primary procedure prior to referral. lntravitreal SF[6] injection was the primary procedure in 12 eyes with localized detachments; the retina became attached in 5 [41.6%] of these eyes, however redetachment occurred in 7 [584%] eyes. Overall, 23 eyes [including 7 failed scleral buckling cases, 7 redetachments following SF[6] injection and 9 cases of primary surgery] underwent vitrectomy with use of high viscosity silicone oil. No major complications occurred during the operations. Overall, final anatomical success was 92.9% and visual improvement occurred in 85.7% of the eyes. In highly myopic eyes with RD due to macular hole, less invasive procedures such as SF[6] injection seem to be appropriate for eyes with localized detachment. In cases of total or subtotal RD and posterior staphyloma, pars plana vitrectomy and silicone oil tamponade seem to be the preferred procedure

Trans-scleral fixation of posterior chamber intraocular lens combined with vitreoretinal surgery

To report the outcomes of trans-scleral fixation of posterior chamber intraocular lens [PCIOL] combined with complete vitrectomy and prophylactic band placement. Hospital records of 18 patients who underwent the procedure were reviewed. Indications for vitreoretinal surgery included previous penetrating ocular trauma, complicated cataract surgery and vitreous incarceration, and chronic cystoid macular edema. All, patients had iris and angle damage with inadequate lens capsular support. Age, sex, surgical technique, follow up duration and pre- and postoperative best corrected visual acuity [BCVA] were evaluated. Overall 18 eyes of 18 patients [14 men and 4 women] with mean age of 34.8 +/- 23 [range 5-76] years were operated. Mean follow up duration was 36 +/- 32.4 [range 6-96] months. Of the 18 operated eyes 7 were aphakic, 6 had complete IOL dislocation into the vitreous cavity, 4 had subluxated cataractous lens and one had a subluxated IOL. The number of eyes with BCVA >/= 20/40 increased from 3 [16.7%] preoperatively to 9 [50%] postoperatively [P < 0.01]. Postoperative complications were encountered in 9 eyes and included uveitis, vitreous hemorrhage, repeat JUL dislocation and retinal detachment. In the absence of adequate capsular support, trans-scleral fixation of a PCIOL combined with vitreoretinal surgery seems to be effective for visual rehabilitation in selected patients with complicated cataracts or previous cataract surgery. Application of this technique in children deserves caution. Larger studies and a randomized clinical trial with long-term follow up are required to confirm these results