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Email: [email protected]. Macular hole and rhegmatogenous retinal detachment .... Email: stefan.mennel@lycos.com. Acta Ophthalmologica 2012 e74.
Acta Ophthalmologica 2012

retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 114: 2142–2154. Kreissig I, Simader E & Rose D (1994): Role of segmental buckling surgery in treatment of stages B and C proliferative vitreoretinopathy detachment. A long-term follow-up. Klin Monatsbl Augenheilkd 205: 336–343. Mennel S, Kicova N & Callizo J (2010): Scleral buckling in rhegmatogenous retinal detachment with concomitant full-thickness macular hole. Acta Ophthalmol. (Epub ahead of print). Mirza RG, Johnson MW & Jampol LM (2007): Optical coherence tomography use in evaluation of the vitreoretinal interface: a review. Surv Ophthalmol 52: 397–421. Wolfensberger Thomas J & Gonvers M (1999): Long-term follow-up of retinal detachment due to macular hole in myopic eyes treated by temporary silicone oil tamponade and laser photocoagulation. Ophthalmology 106: 1786–1791.

Correspondence: Vinod Kumar, MS DNB MNAMS FRCS(Glasg) 9 ⁄ 2, Punjabi Bagh Extension New Delhi 110026 India Tel: 91-9868420620 Fax: 91-1122156295 Email: [email protected]

Macular hole and rhegmatogenous retinal detachment Stefan Mennel, Nadia Kicova and Josep Callizo Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany doi: 10.1111/j.1755-3768.2011.02107.x

Editor,

W

e read with interest the letter by Kumar & Chanana (2010) and appreciate their comments on our article ‘Scleral buckling in rhegmatogenous retinal detachment with concomitant full-thickness macular hole’ (Mennel et al. 2010). We reported that buckling of the peripheral breaks in the presence of a full-thickness macular hole (MH) can be sufficient to reattach the retina. Although proliferative vitreoretinopathy (PVR Cp1) was present, an extraocular procedure without drainage was performed. The

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closure of the MH could be demonstrated by OCT within 2 months after surgery. Kumar and Chanana point out the lack of randomized controlled trials evaluating the incidence of PVR after pars plana vitrectomy (PPV) and scleral buckling (SB). They also mention that no statistically significant difference was found in the rates of PVR development between SB and PPV in the SPR study (Heimann et al. 2007). However, parameters such as the inclusion criteria and the experience of the surgeon should be taken into consideration when interpreting such multicentric studies with several surgeons. Even after a procedure is chosen, several intraoperative factors, e.g. time and extent of cryopexy, performance of subretinal drainage, tamponade, presence of haemorrhage or combining procedures may influence the outcome and PVR formation. We agree with Kumar and Chanana that for retinal detachment (RD) with severe PVR pars plana vitrectomy is the method of choice. In our case, the eye presented PVR C and as Kumar and Chanana also mention, it can be successfully treated by scleral buckling. Sivkova & Kreissig (2002) demonstrated that PVR stage B and C can be managed by scleral buckling alone to reattach the retina and reduce PVR formation. If a full-thickness hole is present preoperatively, there is a risk of enlarging it and of damaging the pigment epithelium or, if a lamellar hole or a pseudohole is present, of inducing a full-thickness MH when perfoming PPV, especially by carrying out a central drainage. Additionally, a MH may occur in 0.9% of the cases after successful reattachment (Benzerroug et al. 2008). Therefore, we recommend performing preoperatively an OCT examination to distinguish full-thickness MH, lamellar MH and pseudohole. Nevertheless, it should be considered that a differentiation of pseudohole and lamellar hole may not be possible in all cases and that a pseudohole may progress into a lamellar MH (Bottoni et al. 2008; Michalewski et al. 2010). Benzerroug et al. (2008) described the results of surgery on MH developed after RD repair. In 9 of 1007 eyes, MH formation occured after RD repair. The primary procedure to reattach the retina was in one case pneu-

matic retinopexy, in three cases PPV and in five cases buckling procedure. As the buckling procedure was combined with intraocular gas (pneumatic retinopexy) in most of the cases, it cannot be concluded that SB causes postoperative macular hole formation after RD repair more often than PPV. In summary, in the presence of a full-thickness MH and peripheral retinal breaks, buckling of the peripheral breaks can be sufficient to reattach the retina. OCT is a helpful tool to evaluate the macula prior to retinal detachment surgery and might help to decide the surgical strategy.

References Benzerroug M, Genevois O, Siahmed K & Nasser Z (2008): Results of surgery on macular holes that develop after rhegmatogenous retinal detachment. Br J Ophthalmol 92: 217–9. Bottoni F, Carmassi L, Cigada M, Moschini S & Bergamini F (2008): Diagnosis of macular pseudoholes and lamellar macular holes: is optical coherence tomography the ‘gold standard’? Br J Ophthalmol 92: 635–9. Heimann H, Bartz-Schmidt KU, Bornfeld N, Weiss C, Hilgers RD, Foerster MH & Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group. (2007): Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study. Ophthalmology 114: 2142–54. Kumar V & Chanana B (2010): Scleral buckling in rhegmatogenous retinal detachment with concomitant full-thickness macular hole. Acta Ophthalmol [Epub ahead of print]. Mennel S, Kicova N & Callizo J (2010): Scleral buckling in rhegmatogenouos retinal detachment with concomitant fullthickness macular hole. Acta Ophthalmol [Epub ahead of print]. Michalewski J, Michalewska Z, Dzie˛gielewski K & Nawrocki J (2010): Evolution from macular pseudohole to lamellar macular hole spectral domain OCT study. Graefes Arch Clin Exp Ophthalmol [Epub ahead of print]. Sivkova N & Kreissig I (2002): Rhegmatogenous PVR detachment: long-term results after extraocular minimal scleral buckling. Klin Monatsbl Augenheilkd 219: 519–22. Correspondence: Stefan Mennel Department of Ophthalmology Philipps-University Marburg Robert-Koch-Str. 4 35037 Marburg Germany Tel: 01149 (6421) 5866671 Fax: 01149 (6421) 586 5678 Email: [email protected]