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.

BACKGROUND: We sought to evaluate the surgical outcomes of macular hole without retinal detachment in high myopia to assess anatomical closure of macular holes using optical coherence tomography (OCT) and to compare these results with those from controls.

METHODS: In this retrospective case-control study, 42 consecutive eyes of 41 patients received vitrectomy with internal limiting membrane removal for macular hole without retinal detachment between August 2008 and September 2010. Two groups were created: eight eyes with high myopia (-6.00 diopters of refractive error or greater and axial length longer than 26.0 mm) and 34 eyes without high myopia. Diagnosis and staging of macular hole were defined by biomicroscopy findings and confirmed by OCT. Outcome measures were visual acuity (VA), closure of the macular hole and complications.

RESULTS: Anatomical closure of the macular hole confirmed by OCT was less favorable and was achieved in only five of eight eyes (62.5%) with high myopia, compared to 32 of 34 eyes (94.1%) in the control group (p = 0.040; Fisher's exact test). At the final follow-up, the mean logMAR VA improved significantly in the group with high myopia, from 0.92 to 0.63 (p = 0.023; two-tailed, paired t test); in the control group, it improved from 1.02 to 0.48 (p < 0.001; two-tailed, paired t test). There was no significant difference between the 2 groups in visual outcomes (p = 0.17; two-tailed t test). However, in pseudophakic eyes, the mean of the final VA was worse in highly myopic eyes (0.74 logMAR) than in control eyes (0.40 logMAR) (p = 0.016; two-tailed t test). The only complication was peripheral retinal detachment in one eye in the highly myopic group (12.5%).

CONCLUSIONS: Both groups benefited from macular hole surgery, with significant visual improvement. However, complete closure of the macular hole and visual outcomes after internal limiting membrane removal were less successful in highly myopic eyes.