Posterior vitreous detachment in highly myopic eyes undergoing vitrectomy

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Abstract

Purpose

To review the PVD status in highly myopic eyes requiring vitreoretinal surgery, using intraoperative observation

Methods

In a retrospective study, patients presenting with high myopia with refractive error<-6,00D, axial length>26mm or fundus signs of high myopia, who underwent their first intraocular vitreoretinal surgery in our department between 2009 and 2012 were included. Standard 25G-pars plana vitrectomy was performed for all, with or without staining. The main outcome was the intraoperative identification of a PVD. Age at the time of surgery and preoperative slit-lamp observation of PVD were also collected.

Results

Ninety-six eyes of 95 patients were included. Eyes were categorized by disease: myopic foveoschisis (FVS), epiretinal membrane (ERM), macular hole (MH), macular hole retinal detachment (MHRD) and rhegmatogenous retinal detachment (RD). Mean age was 62.15 years (range 29-95). RE was available for 67 eyes: mean value -13.9D. Mean AL on 38 eyes was 29.2mm. A PVD was found in 52.1 % of the 96 eyes, and a dye was used in 81 eyes. In MH, FVS, MHRD, ERM and RD groups, the PVD rate were respectively 10%, 14.3%, 42.9%, 74.2% and 85%. Reliability of preoperative slit lamp examination in detecting the PVD showed a 70% sensibility, 76% specificity, 75% positive predictive value and 70% negative predictive value.

Conclusion

In highly myopic eyes when ERM and RD groups the PVD rate was not so far from emmetropic eyes, in case of RDMH, MH and FVS this rate was found very low. Nearly 90% of highly myopic eyes with FVS or MH have their posterior vitreous cortex still attached. As the assessment of PVD in these eyes is very challenging, the use of any dye or visualization agent during theses surgeries seems then advisable.

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