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Myopic Macular Hole

Retinography of the left eye. Postoperative, showing persistence of superior C3F8 gas bubble and amniotic membrane graft over the fovea, in the context of changes in the pigment epithelium of the macular area.

Foveal cross-section of the left eye showing the correct placement of the amniotic membrane (hyperreflective foveal deposit).

Description

Myopic macular hole (MMH) is a rare entity associated with retinochoroidal and retinal pigment epithelium atrophy, as well as the presence of posterior staphyloma, common findings in highly myopic eyes. The closure rate of MMH after the standard technique, consisting of posterior vitrectomy and internal limiting membrane peeling, is lower than that of idiopathic macular hole, with varying results according to different studies.

Although functional recovery after MMH closure may be limited in some cases, surgery is recommended to prevent the development of posterior pole retinal detachment, a frequently associated complication.

Comments

Indication

A 49-year-old male with high myopia (axial length of 34.67mm) consults due to low vision in his left eye with an 8-year evolution. Upon examination, corrected visual acuity is found to be 1.0 in the right eye and 0 “1 in the left eye (decimal scale, Snellen). He had undergone surgery for a myopic macular hole three years prior using posterior vitrectomy technique with internal limiting membrane peeling and gas exchange, without achieving hole closure. Given that it was a macular hole with low probability of closure, we proposed performing a vitrectomy with amniotic membrane implant and final exchange with 14% C3F8 gas, which resulted in anatomical closure of the hole (Figure 1) with a slight functional improvement, with final visual acuity of 0” 2. Three years after the amniotic membrane implant, it remains well positioned (Figure 2) and we have not observed complications associated with the technique.