Comparison of primary gas tamponade and a vitrectomy for repair of macular holes with retinal detachment in highly myopic eyes

A preference for the primary use of standard gas tamponade or a vitrectomy combined with other adjuvant measures to treat myopic eyes with macular holes (MHs) and retinal detachment (RD) has not been established. This article evaluates postoperative outcomes of both surgeries, and recommends a surgical method based on the findings. We reviewed the records of 61 patients (62 eyes) with high myopia (> -6.0 diopter, > 26 mm of axial length, or visible posterior staphyloma) and MHs with secondary RD (no peripheral retinal break) who were treated between April 1986 and September 2002 in southern Taiwan. Descriptive statistics of baseline examinations and results of the operations were retrospectively analyzed. Baseline clinical data of the primary gas tamponade and vitrectomy groups did not significantly differ, except for the mean preoperative log (minimum angle of resolution) visual acuity (VA) (p = 0.016) and extent of RD (p = 0.001, located in the posterior staphyloma only). None of the results (including success rate, cause of failure, number of operations until stability was achieved, and mean duration of postoperative follow-up) of the operations in the 2 groups significantly differed, except for the improved VA at the final status (p = 0.03). Among highly myopic eyes with MHs, we suggest a vitrectomy for those with poorer VA and a greater extent of RD. However, gas tamponade is strongly recommended for those with RD with posterior staphyloma (PS) only because this procedure is safer and requires no sophisticated instruments.