Reopening of macular holes in highly myopic eyes with retinal detachments

Background: Gas tamponade with or without vitrectomy is commonly used to treat retinal detachment resulting from a macular hole in a highly myopic eye. Redetachment of the retina occurs frequently, however, and the pathogenesis of redetachment is unclear. One possible mechanism leading to redetachment is tangential traction caused by an epiretinal membrane of the posterior retina. Methods: Eleven consecutive highly myopic eyes with retinal detachment resulting from a macular hole were treated by vitrectomy, gas or silicone oil tamponade, and removal of an epiretinal membrane. Surgical outcomes and clinical characteristics of these patients were reviewed. Results: An epiretinal membrane was found to be present in all eyes. Of 11 eyes, removal of an epiretinal membrane was complete in six eyes, and macular holes remained closed in all 6 eyes. In five of the 11 eyes, removal of the epiretinal membrane was incomplete. In four of these five eyes, the macular hole reopened. Conclusion: Reopening of the macular holes most likely were caused by tangential traction of the remaining epiretinal membranes. II seems that it is important to remove epiretinal membranes as completely as possible during vitrectomy for retinal detachment resulting from a macular hole in a highly myopic eye.