Anatomical and functional results of macular hole retinal detachment surgery in patients with high myopia and posterior staphyloma treated with perfluoropropane gas or silicone oil.

Purpose: To evaluate the use of perfluoropropane gas (C3F8) versus silicone oil (SO) for retinal detachment secondary to macular hole in patients with high myopia and posterior staphyloma.

Methods: In a retrospective study, 30 eyes of 30 patients underwent pars plana vitrectomy, and C3F8 (17 patients) or SO (13 patients) tamponade; internal limiting membrane peeling was performed successfully at the first surgery in 23 patients. High-density silicone oil tamponade was used for reoperations.

Results: The mean values of patients' characteristics were as follows: age, 57.7 years; axial length, 29.02 mm; spherical equivalent refraction, -15.40 diopters; initial best-corrected visual acuity, 2.35 logarithm of the minimum angle of resolution; final best-corrected visual acuity, 1.59 logarithm of the minimum angle of resolution. In C3F8 group, best-corrected visual acuity significantly improved (P < 0.001), passing from 2.34 to 1.36 logarithm of the minimum angle of resolution. Vision improvement from blindness to low vision was significantly greater (P = 0.009) in C3F8 group (16 of 17; 94%) than in SO group (6 of 13; 46%). A significant higher initial success (P = 0.025) was found in the C3F8 group (16 of 17; 94%) than in the SO group (7 of 13; 54%). Proliferative vitreoretinopathy was the cause of initial failure; all these subjects achieved anatomical success after being reoperated with high-density silicone oil tamponade.

Conclusion: C3F8 and internal limiting membrane peeling could represent the most effective strategy in highly myopic patients with macular hole retinal detachment. Other tamponade agents must be investigated.