Management of central retinal detachment due to a macular hole

Abstract

Central retinal detachment due to macular holes has been encountered in highly myopic eyes with posterior staphylomata. Such cases occur in about 1% of retinal detachments. Two types of cases may be distinguished: Favorable cases are those with a limited central retinal detachment which flattens perfectly after volume reduction and drainage of the bottom of the posterior staphyloma. This allows very limited and controlled macular photocoagulation, which preserves the function of the central area. These patients obtain the greatest benefit; most of them have useful vision and can get about unaided. Unfavorable cases are those with longstanding extensive central detachment and excessive vitreous liquefaction which do not flatten by volume reduction and drainage. The eye becomes very soft with the central retina still detached. These cases should be buckled in the macular area using a silastic rod. Cryocoagulation allows direct visualization of the reaction in the macular area. Air injection is usually required at the end of the operation to complete the drainage and provide vitreous replacement. Air in the vitreous cavity will push the retina into the base of the posterior staphyloma and this will restore tension and provide support for the retina for several days.