Evaluation of the efficacy of posterior scleral contraction in the treatment of macular hole with retinal detachment in high myopia Macular surgery on sclera.

PURPOSE To evaluate efficacy of posterior scleral contraction (PSC) for macular hole with retinal detachment (MHRD) in high myopia. METHODS Seventy-three MHRD eyes were treated with PSC. A strip was sent across inferior-temporal scleral surface to posterior pole, then two ends were led out from nasal-inferior and temporal-superior areas. It was tightened to contract posterior sclera with designed axial length (AL) shortening ([10% of pre-operative AL-0.5]mm) after aqueous humors drained from anterior chamber. Recovery was classified as type I (retinal reattachment with MH bridged) and II (retinal reattachment without MH bridged). Follow-up duration was 25.3±18.0 months. RESULTS AL was 30.01±2.27mm at pre-operation and shortened by 2.57±0.82mm intra-operatively. At final post-operation, maintained AL shortening was 1.87±0.92mm. Forty-six eyes (63.0%) recovered as type I and 26 eyes (35.6%) as type II, 1 eye (1.4%) unrecovered. Post-operative best-corrected visual acuity (BCVA, logarithm of minimal angle of resolution [LogMAR]) was better than pre-operative one (0.85±0.50 [Snellen 20/125] vs. 1.11±0.56 [Snellen 20/250], P<0.001) with correlation (r=0.662, P<0.001) and consistency (Kappa=0.34, P<0.001) between two. BCVA improvement didn't differ between recovery types (P=0.206). CONCLUSION MHRD was successfully recovered by PSC with AL shortening. Visual improvement was achieved, correlated and consistent with pre-operative BCVA while independent of recovery types.