Anatomical and visual outcomes after episcleral macular buckling compared with those after pars plana vitrectomy for retinal detachment caused by macular hole in highly myopic eyes

Purpose: To report anatomical and visual outcomes after episcleral macular buckling (EMB) and pars plana vitrectomy (PPV) for retinal detachment caused by macular hole in highly myopic eyes with posterior staphyloma. Patients and Methods: This retrospective, interventional case series included 58 eyes of 58 patients with retinal detachment caused by macular hole in highly myopic eyes with posterior staphyloma and geographic chorioretinal atrophy. The cases were assigned to 2 groups according to the surgical technique: the EMB group (30 eyes) underwent posterior episcleral buckling using a solid silicone plate specifically designed for macular indentation, and the PPV group (28 eyes) underwent PPV combined with fluid-gas exchange. Baseline clinical data including age, sex, refractive errors, and degree of retinal detachment did not differ between EMB and PPV groups. Main outcome measures included ophthalmoscopy findings, three-mirror contact lens biomicroscopy results, and visual acuity at the end of follow-up (mean follow-up, 52.8 months in the EMB group and 44.1 months in the PPV group). Optical coherence tomography was performed in selected cases in the EMB group. Results: In the EMB group, the retinal reattachment rate was 93.3% after primary surgery and 100% after secondary surgery. In the PPV group, the retinal reattachment rate was 50% after primary surgery and 86% after secondary surgery using the EMB procedure, thus indicating a better anatomical success rate after primary EMB than after primary PPV. The mean logarithm of the minimum angle of resolution (logMAR) visual acuity +/- SID in the EMB group increased significantly from 1.45 +/- 0.50 before surgery to 0.92 +/- 0.42 at the end of follow-up (P < 0.001). The mean logMAR visual acuity in the PPV group increased significantly from 1.70 +/- 0.45 before surgery to 1.35 +/- 0.61 at the end of follow-up (P < 0.02). Visual acuity improvement at the end of follow-up was significantly better after EMB than after PPV (P < 0.005). Optical coherence tomography revealed that 10 of 12 eyes with successful indentation of the macular hole area after EMB had complete closure of the macular hole as well as reattachment of the retina, and the remaining 2 eyes had persistent retinal reattachment with the foveal defect. Conclusions: EMB is a preferred surgical procedure for the repair of retinal detachment and macular hole closure in highly myopic eyes with posterior staphyloma.