Anatomical and visual outcomes in high myopic macular hole (HM-MH) without retinal detachment: a review

  • Micol AlkabesEmail author
  • Francesco Pichi
  • Paolo Nucci
  • Domenico Massaro
  • Marco Dutra Medeiros
  • Borja Corcostegui
  • Carlos Mateo
Review Article



To review postoperative anatomical and functional outcomes in high myopic macular hole (HM-MH) without retinal detachment.


In the PubMed database, published articles on myopic macular hole surgery from 2000 to 2013 (present days) were reviewed. Inclusion criteria were high myopia and macular hole (MH). Series with posterior retinal detachment secondary to MH and myopic foveoschisis (MFS) without MH were excluded. Main outcomes included MH closure rate, resolution of the foveoschisis, if present, and postoperative visual acuity. Optical coherence tomography (OCT) features and postoperative evolution were also evaluated when reported.


A total of 131 articles were initially found. After having applied the exclusion criteria, 15 articles were reviewed. Four were focused on HM-MH with concomitant foveoschisis (Schisis Group), and ten included only HM-MH without FS case series (Flat Group). Only one comparative study between these two groups was found. Surgical techniques were observed to be similar for both groups in most series, including vitrectomy with or without internal limiting membrane (ILM) removal, and gas or silicone oil tamponade. However, in one retrospective study, macular buckling was applied together with pars plana vitrectomy in cases of HM-MH with foveoschisis. When available, preoperative and postoperative OCT provided a useful evaluation of the status of the macula. Different prognosis were observed in the two groups in cases of vitreous surgery: anatomical success rate and functional outcomes for HM-MH with foveoschisis were markedly poorer than that for cases of HM-MH without foveoschisis, and multiple procedures might be required. By the contrast, better results seemed to be achieved using the posterior buckle technique for patients with HM-MH and concomitant foveoschisis. Moreover, when compared, final anatomical and functional outcomes seem to be less satisfactory than in emmetropic eyes. Postoperative non-closure or reopening of the macular hole is more common in eyes with HM-MH and concomitant foveoschisis, and possible retinal detachment may occur in these patients.


Despite similar surgical procedures, anatomical and functional results after vitreous surgery in cases of HM-MH may be very different from series to series. The prognosis is generally better in cases involving only HM-MH without foveoschisis than in cases with MH and associated foveoschisis. Persistent MHs are more frequent in eyes with concomitant retinoschisis, and this seems to represent a possible risk factor for late retinal detachment in the case of unsuccessful vitreous surgery. However, although vitrectomy can lead to anatomical and visual improvements, an higher axial length > 30 mm and the presence of a posterior staphyloma seem to remain the two most important risk factors for poor visual outcomes. For these reasons, a different surgical approach, including macular buckling, might be considered in casse of HM-MH and concomitant myopic foveoschisis, in order to counteract the traction exerted by the posterior staphyloma.


Macular hole High myopia Foveoschisis Surgery 


Financial disclosure(s)


Conflict of interests



  1. 1.
    Coppé AM, Ripandelli G (2003) Optical coherence tomography in the evaluation of vitreoretinal disorders of the macula in highly myopic eyes. Semin Ophthalmol 18(2):85–88PubMedCrossRefGoogle Scholar
  2. 2.
    Faghihi H, Hajizadeh, Riazi-Esfahani M (2010) Optical coherence tomographic findings in highly myopic eyes. J Ophthalmic Vis Res 121(5):110Google Scholar
  3. 3.
    Tano Y (2002) Pathologic myopia: where are we now? Am J Ophthalmol 134(5):645–660PubMedCrossRefGoogle Scholar
  4. 4.
    Curtin BJ (1977) The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc 75:67–86PubMedCentralPubMedGoogle Scholar
  5. 5.
    Oie Y, Ikuno Y, Fujikado T, Tano Y (2005) Relation of posterior staphyloma in highly myopic eyes with macular hole and retinal detachment. Jpn J Ophthalmol 49(6):530–532PubMedCrossRefGoogle Scholar
  6. 6.
    Matsumura N, Ikuno Y, Tano Y (2004) Posterior vitreous detachment and macular hole formation in myopic foveoschisis. Am J Ophthalmol 138(6):1071–1073PubMedCrossRefGoogle Scholar
  7. 7.
    Sayanagi K, Ikuno Y, Tano Y (2006) Reoperation for persistent myopic foveoschisis after primary vitrectomy. Am J Ophthalmol 141(2):414–417PubMedCrossRefGoogle Scholar
  8. 8.
    Kobayashi H, Kobayashi K, Okinami S (2002) Macular hole and myopic refraction. Br J Ophthalmol 86:1269–1273PubMedCrossRefGoogle Scholar
  9. 9.
    Alkabes M, Padilla L, Salinas C, Nucci P, Vitale L, Pichi F, Burès-Jelstrup A, Mateo C (2013) Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis. Graefes Arch Clin Exp Ophthalmol 251(11):2521–2527. doi: 10.1007/s00417-013-2347-y PubMedCrossRefGoogle Scholar
  10. 10.
    Jo Y, Ikuno Y, Nishida K (2012) Retinoschisis: a predictive factor in vitrectomy for macular holes without retinal detachment in highly myopic eyes. Br J Ophthalmol 96(2):197–200. doi: 10.1136/bjo.2011.203232 PubMedCrossRefGoogle Scholar
  11. 11.
    Kono T, Takesue Y, Shiga S (2006) Scleral resection technique combined with vitrectomy for a macular hole retinal detachment in highly myopic eyes. Ophthalmologica 220(3):159–163PubMedCrossRefGoogle Scholar
  12. 12.
    Nakagawa N, Parel JM, Murray TG, Oshima K (2000) Effect of scleral shortening on axial length. Arch Ophthalmol 118(7):965–968PubMedGoogle Scholar
  13. 13.
    Tanaka T, Ando F, Usui M (2005) Episcleral macular buckling by semirigid shaped-rod exoplant for recurrent retinal detachment with macular hole in highly myopic eyes. Retina 25:147–151PubMedCrossRefGoogle Scholar
  14. 14.
    Qian J, Jiang YR (2010) Anatomic evaluation of macular holes with silicone oil tamponades in highly myopic eyes using optical coherence tomography. Eur J Ophthalmol 20(5):938–944PubMedGoogle Scholar
  15. 15.
    El Rayes EN, Oshima Y (2013) Supra choroidal buckling in managing myopic vitreoretinal interface disorders: 1-year data. Retina. doi: 10.1097/IAE.0b013e31828fcb77 PubMedGoogle Scholar
  16. 16.
    Yonekawa Y, Hirakata A, Inoue M, Okada AA (2010) Spontaneous closure of a recurrent myopic macular hole previously repaired by pars plana vitrectomy. Acta Ophthalmol 89(6):e536–e537PubMedCrossRefGoogle Scholar
  17. 17.
    Bonnet M, Semiglia R (1993) Late recurrences after successful surgery for retinal detachment with macular hole. Graefes Arch Clin Exp Ophthalmol 231:347–350PubMedCrossRefGoogle Scholar
  18. 18.
    Seike C, Kusaka S, Sakagami K, Ohashi Y (1997) Reopening of macular holes in highly myopic eyes with retinal detachments. Retina 17(1):2–6PubMedCrossRefGoogle Scholar
  19. 19.
    Sayanagi K, Ikuno Y, Tano Y (2005) Macular hole diameter after vitrectomy for macular hole and retinal detachment. Retina 25(5):608–611PubMedCrossRefGoogle Scholar
  20. 20.
    Ikuno Y, Tano Y (2006) Vitrectomy for macular holes associated with myopic foveoschisis. Am J Ophthalmol 141(4):774–776PubMedCrossRefGoogle Scholar
  21. 21.
    Burés-Jelstrup A, Alkabes M, Gómez-Resa M, Rios J, Corcostegui B, Mateo C (2013) Visual and anatomical outcome after macular buckling for macular hole with associated foveoschisis in highly myopic eyes. Br J Ophthalmol. doi: 10.1136/bjophthalmol-2013-304016 PubMedGoogle Scholar
  22. 22.
    Sulkes DJ, Smiddy WE, Flynn HW, Feuer W (2000) Outcomes of macular hole surgery in severely myopic eyes: a case–control study. Am J Ophthalmol 130:335–339PubMedCrossRefGoogle Scholar
  23. 23.
    Patel SC, Loo RH, Thompson JT, Sjaarda RN (2001) Macular hole surgery in high myopia. Ophthalmology 108:377–380PubMedCrossRefGoogle Scholar
  24. 24.
    Garcia-Arumi J, Martinez V, Puig J, Corcostegui B (2001) The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment. Retina 21:332–338PubMedCrossRefGoogle Scholar
  25. 25.
    Kwok AKH, Lai TYY (2003) Internal limiting membrane removal in macular hole surgery for severely myopic eyes: a case–control study. Br J Ophthalmol 87:885–889PubMedCrossRefGoogle Scholar
  26. 26.
    Suda K, Hangai M, Yoshimura N (2011) Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography. Am J Ophthalmol 115(1):118–127.e1CrossRefGoogle Scholar
  27. 27.
    Qu J, Zhao M, Jiang Y, Li X (2012) Vitrectomy outcomes in eyes with high myopic macular hole without retinal detachment. Retina 32(2):275–280PubMedCrossRefGoogle Scholar
  28. 28.
    Wu TT, Kung YH (2012) Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case–control study using optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 250:327–331PubMedCrossRefGoogle Scholar
  29. 29.
    Kuriyama S, Hayashi H, Jingami Y, Kuramoto N, Akita J, Matsumoto M (2013) Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia. Am J Ophthalmol 156(1):125–131.e1. doi: 10.1016/j.ajo.2013.02.014 PubMedCrossRefGoogle Scholar
  30. 30.
    Michalewska Z, Michalewski J, Adelman RA, Nawrocki J (2010) Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology 117(10):2018–2025. doi: 10.1016/j.ophtha.2010.02.011 PubMedCrossRefGoogle Scholar
  31. 31.
    Ikuno Y, Tano Y (2003) Early macular holes with retinoschisis in highly myopic eyes. Am J Ophthalmol 136(4):741–744PubMedCrossRefGoogle Scholar
  32. 32.
    Matsumura N, Ikuno Y, Tano Y (2004) Posterior vitreous detachment and macular hole formation in myopic foveoschisis. Am J Ophthalmol 138(6):1071–1073PubMedCrossRefGoogle Scholar
  33. 33.
    Wollensak G, Spoerl E, Grosse G, Wirbelauer C (2006) Biomechanical significance of the human internal limiting lamina. Retina 26(8):965–968PubMedCrossRefGoogle Scholar
  34. 34.
    Ikuno Y, Gomi F, Tano Y (2005) Potent retinal arteriolar traction as a possible cause of myopic foveoschisis. Am J Ophthalmol 139(3):462–467PubMedCrossRefGoogle Scholar
  35. 35.
    Sun CB, Liu Z, Xue AQ, Yao K (2010) Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes. Eye (Lond) 24(12):1787–1791CrossRefGoogle Scholar
  36. 36.
    Alkabes M, Salinas C, Vitale L, Burès A, Nucci P, Mateo C (2011) En face optical coherence tomography of inner retinal defects after internal limiting membrane peeling for idiopathic macular hole. Invest Ophthalmol Vis Sci 52(11):8349–8355PubMedCrossRefGoogle Scholar
  37. 37.
    Pichi F, Lembo A, Morara M, Veronese C, Alkabes M, Nucci P, Ciardella AP (2013) Early and late inner retinal changes after inner limiting membrane peeling. Int Ophthalmol. doi: 10.1007/s10792-013-9831-6 Google Scholar
  38. 38.
    Steven P, Laqua H, Wong D, Hoerauf H (2006) Secondary paracentral retinal holes following internal limiting membrane removal. Br J Ophthalmol 90:293–295PubMedCrossRefGoogle Scholar
  39. 39.
    Kozak I, Freeman WR (2006) Nonprogressive extrafoveal retinal hole after foveal epiretinal membrane removal. Am J Ophthalmol 141(4):769–771PubMedCrossRefGoogle Scholar
  40. 40.
    Mason JO 3rd, Feist RM, Albert MA Jr (2007) Eccentric macular holes after vitrectomy with peeling of epimacular proliferation. Retina 27(1):45–48PubMedCrossRefGoogle Scholar
  41. 41.
    Shimada N, Ohno-Matsui K, Baba T, Futagami S, Tokoro T, Mochizuki M (2006) Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment. Am J Ophthalmol 142:497–500PubMedCrossRefGoogle Scholar
  42. 42.
    Shimada N, Ohno-Matsui K, Yoshida T, Sugamoto Y, Tokoro T, Mochizuki M (2008) Progression from macular retinoschisis to retinal detachment in highly myopic eyes is associated with outer lamellar hole formation. Br J Ophthalmol 92:762–764PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Ikuno Y, Sayanagi K, Oshima T, Gomi F, Kusaka S, Kamei M, Ohji M, Fujikado T, Tano Y (2003) Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes. Am J Ophthalmol 136(3):477–481PubMedCrossRefGoogle Scholar
  44. 44.
    Ripandelli G, Coppé AM, Fedeli R, Parisi V, D’Amico DJ, Stirpe M (2001) Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes: a comparison [corrected] of vitrectomy versus posterior episcleral buckling surgery. Ophthalmology 108(12):2258–2264, discussion 2265PubMedCrossRefGoogle Scholar
  45. 45.
    Theodossiadis GP, Theodossiadis PG (2005) The macular buckling procedure in the treatment of retinal detachment in highly myopic eyes with macular hole and posterior staphyloma: mean follow-up of 15 years. Retina 25:285–289PubMedCrossRefGoogle Scholar
  46. 46.
    Alkabes M, Burés-Jelstrup A, Salinas C, Medeiros MD, Rios J, Corcostegui B, Mateo C (2013) Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study. Graefes Arch Clin Exp Ophthalmol. doi: 10.1007/s00417-013-2497-y Google Scholar
  47. 47.
    Mateo C, Dutra Medeiros M, Alkabes M, Burés-Jelstrup A, Postorino M, Corcóstegui B (2013) Illuminated ando plombe for optimal positioning in highly myopic eyes with vitreoretinal diseases secondary to posterior staphyloma. JAMA Ophthalmol 131(10):1359–1362. doi: 10.1001/jamaophthalmol.2013.4558 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Micol Alkabes
    • 1
    • 2
    • 3
  • Francesco Pichi
    • 1
  • Paolo Nucci
    • 1
  • Domenico Massaro
    • 1
  • Marco Dutra Medeiros
    • 2
  • Borja Corcostegui
    • 2
  • Carlos Mateo
    • 2
  1. 1.Clinica Oculistica–Ospedale San GiuseppeUniversità di MilanoMilanItaly
  2. 2.IMO – Instituto de Microcirugía OcularBarcelonaSpain
  3. 3.San Giuseppe Hospital – Eye ClinicMilanItaly

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