The clinical characteristics of rhegmatogenous retinal detachments with both peripheral retinal breaks and macular holes

doi:10.3877/cma.j.issn.2095-2007.2025.05.002

Abstract

Abstract:

Objective

To explore the clinical characteristics, diagnosis and treatment methods, and prognosis of retinal detachment caused by peripheral retinal holes combined with macular holes (MH).

Methods

A total of 20 patients (20 eyes) diagnosed with peripheral retinal tears combined with MH retinal detachment were collected at the Ophthalmic Center of Beijing Tongren Hospital affiliated to Capital Medical University from November 2020 to October 2023. Among them, there were 11 males (11 eyes) and 9 females (9 eyes) with an average age (51.8±10.5) years old (ranging from 30 to 67 years old). The patient′s medical history, conduct routine examinations before surgery and at 1 month, 3 months, and 1 year follow-up after surgery were recorded to determine the best corrected visual acuity, anterior segment, and fundus condition of the affected eye. The case data was described using the number of cases (eyes) and percentage.

Results

Among the 20 patients (20 eyes) with peripheral retinal holes, 13 (13 eyes) were diagnosed with MH before surgery and 7 (7 eyes) were diagnosed with MH during surgery, accounting for 65% (13/20) and 35% (7/20), respectively. After undergoing 25G/23G minimally invasive vitrectomy and initial scleral buckle surgery, 18 cases (18 eyes) and 2 cases (2 eyes) were found to have missed MH and underwent 25G minimally invasive vitrectomy again, accounting for 90% (18/20) and 10% (2/20), respectively; 17 cases (17 eyes) and 3 cases (3 eyes) were filled with silicone oil or perfluoropropane during surgery, accounting for 85% (17/20) and 15% (3/20), respectively; 19 cases (19 eyes) and 1 case (1 eye) of retinal detachment were treated with one surgery and two surgeries, respectively, accounting for 95% (19/20) and 5% (1/20), respectively. There were 18 cases (18 eyes) and 2 cases (2 eyes) of postoperative MH closure and MH non closure, accounting for 90% (18/20) and 10% (2/20), respectively; The postoperative visual acuity improved, remained unchanged, and decreased in 18 cases (18 eyes), 1 case (1 eye), and 1 case (1 eye), respectively, accounting for 90% (18/20), 5% (1/20), and 5% (1/20), respectively.

Conclusions

Patients with peripheral retinal tears and retinal detachment may develop MH during the course of their condition, which can occur at the time of initial diagnosis, admission, surgery, and during the operation. Therefore, it is not enough to rely solely on initial diagnosis. Attention should also be paid to whether MH occurs during hospitalization, surgery, and surgery to avoid missed diagnosis and treatment. Vitrectomy combined with inert gas or silicone oil filling is an effective treatment for peripheral retinal detachment with MH.

Key words: Rhegmatogenous retinal detachment, Retinal tear, Macular hole, Vitrectomy

Cong Wang, Liyun Jia, Xusheng Cao, Haiying Zhou, Jinqiong Zhou, Bin Mo, Hong Wang, Kai Ma, Yongpeng Zhang. The clinical characteristics of rhegmatogenous retinal detachments with both peripheral retinal breaks and macular holes[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2025, 15(05): 263-267.

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References 30

[1]	Ryan EH, Bramante CT, Mittra RA, et al. Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling [J]. Am J Ophthalmol, 2011, 152(5): 815-819.
[2]	Riordan-Eva P, Chignell AH. Full thickness macular breaks in rhegmatogenous retinal detachment with peripheral retinal breaks[J]. Br J Ophthalmol, 1992, 76(6): 346-348.
[3]	Ciarmatori N, Pellegrini M, Nasini F, et al. The state of intraoperative OCT in vitreoretinal surgery: recent advances and future challenges[J]. Tomography, 2023, 9(5): 1649-1659.
[4]	Parolini B, Ripa M, Frisina R, et al. The role of the intraoperative optical coherence tomography for vitreoretinal surgery in a real-life setting[J]. Life (Basel), 2023, 13(9): 1813.
[5]	Seider MI, Carrasco-Zevallos OM, Gunther R, et al. Real-time volumetric imaging of vitreoretinal surgery with a prototype microscope-integrated swept-source OCT device[J]. Ophthalmol Retina, 2018, 2(5): 401-410.
[6]	Carrasco-Zevallos OM, Keller B, Viehland C, et al. Optical coherence tomography for retinal surgery[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): 37-50.
[7]	Bansal A, Lee WW, Felfeli T, et al. Real-time In vivo assessment of retinal reattachment in humans using swept-source optical coherence tomography[J]. Am J Ophthalmol, 2021, 227: 265-274.
[8]	Ung C, Miller JB. Intraoperative optical coherence tomography in vitreoretinal surgery[J]. Semin Ophthalmol, 2019, 34(4): 312-316.
[9]	Hahn P, Migacz J, O′Connell R, et al. The use of optical coherence tomography in intraoperative ophthalmic imaging[J]. Ophthalmic Surg Lasers Imaging, 2011, 42: 85-94.
[10]	O′Driscoll AM, Goble RR, Kirkby GR. Vitrectomy for retinal detachments with both peripheral retinal breaks and macular holes[J]. Retina, 2001, 21(3): 221-225.
[11]	Shukla D, Kalliath J, Srinivasan K, et al. Management of rhegmatogenous retinal detachment with coexisting macular hole[J]. Retina, 2013, 33(3): 571-578.
[12]	Najafi M, Brown JS, Rosenberg KI. Increased Reoperation Rate in Surgical Treatment of Rhegmatogenous Retinal Detachment with Coexistent Macular Hole[J]. Ophthalmol Retina, 2018, 2(3): 187-191.
[13]	黄国舜，赵春阳. 23G玻璃体切除术治疗黄斑裂孔伴有周边裂孔性视网膜脱离[J]. 吉林医学，2013，34(1)：23-24.
[14]	明媚，杨安怀，邢怡桥，等. 巩膜外加压联合玻璃体腔注气术治疗黄斑裂孔合并周边裂孔性视网膜脱离[J]. 临床眼科杂志，2011，19(1)：43-45.
[15]	范银波，张改丽，肖云，等. 巩膜扣带术治疗周边裂孔继发黄斑裂孔视网膜脱离的临床观察[J]. 临床眼科杂志，2011，19(2)：107-108.
[16]	李敏，赵昕，钟海彬，等. 黄斑裂孔合并周边裂孔视网膜脱离的治疗分析[J]. 临床眼科杂志，2009，17(4)：328-330.
[17]	段安丽，王景昭，陈慧茹. 周边裂孔合并黄斑裂孔视网膜脱离的手术治疗[J]. 中国实用眼科杂志，2002，20 (1)：47-48.
[18]	李爱国，胡玉章，黄建章，等. 黄斑裂孔合并周边裂孔视网膜脱离的手术治疗[J]. 临床眼科杂志，2001，9(1)：63.
[19]	樊莹，张皙. 黄斑裂孔合并周边裂孔视网膜脱离的临床分析[J]. 中国实用眼科杂志，1999，17(5)：291-293.
[20]	Ozturk Y, Aĝîn A, Yucel Gencoglu A, et al. Comparison of Intraocular Tamponade in Patients with Peripheral Tear-Induced Retinal Detachment and Coexisting Macular Hole without High Myopia[J]. Klin Monbl Augenheilkd, 2023, 240(7): 897-902.
[21]	Abouhussein MA, Elbaha SM, Aboushousha M. Human Amniotic Membrane Plug for Macular Holes Coexisting with Rhegmatogenous Retinal Detachment[J]. Clin Ophthalmol, 2020, 24(14): 2411-2416.
[22]	Karabaᶊ L, Seyyar SA, Tokuç EÖ. Management of Retinal Detachment With a Coexistent Macular Hole[J]. Retina, 2023, 43(12): 2199-2203.
[23]	Dhami A, Sharma P, Dhami NB, et al. To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse Flex Loop for failed macular holes[J], Indian J Ophthalmol, 2022, 70(8): 3033-3037.
[24]	Arasaki R, Inoue T, Terasaki H, et al. Macular retinal function after autologous retinal transplantation in patients with refractory macular holes[J], Doc Ophthalmol, 2025, 151(3): 229-237.
[25]	Carlà MM, Mateo C. Autologous retina transplantation for refractory highly myopic macular holes: a long-term follow-up[J]. Jpn J Ophthalmol, 2025, 69(2): 259-267.
[26]	Chen YP, Chen YJ. Inverted internal limiting membrane flap and scleral buckling for retinal detachment with macular hole[J]. BMC Ophthalmol, 2025，25(1): 185.
[27]	Peng KL, Kung YH, Wu TT. Surgical outcomes of inverted internal limiting membrane flap technique for primary rhegmatogenous retinal detachment coexisting with a macular hole[J]. Medicine (Baltimore), 2024, 103(43): e40237.
[28]	Stappler T, Montesel A, Konstantinidis L, et al. Inverted internal limiting membrane flap technique for macular hole coexistent with rhegmatogenous retinal detachment[J]. Retina, 2022, 42(8): 1491-1497.
[29]	Liu X, Huang J, Zhou R, et al. Comparison of internal limiting membrane peeling with the inverted internal limiting membrane flap technique for rhegmatogenous retinal detachment coexisting with macular hole[J]. Retina, 2022, 42(4): 697-703.
[30]	Ling L, Liu Y, Zhou B, et al. Inverted internal limiting membrane flap technique versus internal limiting membrane peeling for vitrectomy in highly myopic eyes with macular hole-Induced retinal detachment[J]. J Ophthalmol, 2020: 2374650.

病例编号	性别	年龄	眼别	眼底情况	术前BCVA	术后BCVA	术后MH闭合	术后视网膜复位
1	女	57	左眼	下方周边部圆孔及马蹄形裂孔，合并MH	0.05	0.3	是	是
2	男	63	右眼	上方长条形变性区两端裂孔，合并MH	手动	0.1	否	是
3	女	44	左眼	先发生鼻下方大马蹄形裂孔，其后发生MH	手动	0.8	是	是
4	男	43	左眼	上方周边马蹄孔，下方周边圆孔，MH合并脉络膜脱离	0.1	0.05	否	是
5	男	34	右眼	上方周边变性区两端裂孔，下方多发裂孔，合并MH	手动	0.4	是	是
6	女	64	右眼	上方变性区一端马蹄形裂孔，合并MH	光感	0.05	是	是
7	男	38	右眼	颞侧周边部巨大视网膜裂孔，合并MH	手动	0.02	是	是
8	女	52	右眼	上方变性区一端马蹄形裂孔，合并MH	手动	0.2	是	是
9	女	59	左眼	周边变性区多发裂孔，合并MH，合并脉络膜脱离	0.01	0.05	是	是
10	男	30	右眼	上方睫状上皮脱离，下方多发裂孔，合并MH	手动	0.02	是	是
11	男	53	左眼	颞上周边部视网膜裂孔，合并MH，合并脉络膜脱离	0.06	0.15	是	是
12	男	59	左眼	先发生颞上马蹄形裂孔，其后发生MH	0.05	0.1	是	是
13	女	55	右眼	周边变性区两个裂孔，合并MH	0.01	0.3	是	是
14	男	49	左眼	颞上，颞下长条形变性区一端撕裂孔，合并MH	指数	0.05	是	是
15	女	65	右眼	颞侧周边部视网膜裂孔，合并MH	0.02	0.02	是	是
16	男	63	右眼	颞侧周边多个马蹄形裂孔，下方多个干孔，合并MH	手动	0.3	是	是
17	女	67	左眼	颞上马蹄形裂孔，合并MH	0.01	0.1	是	是
18	男	51	左眼	颞上条形变性区内裂孔，合并MH	0.05	0.2	是	否
19	男	42	左眼	颞上锯齿缘离断，鼻下裂孔，MH合并脉络膜脱离	0.07	0.1	是	是
20	女	47	右眼	颞上马蹄形裂孔，合并MH	0.06	0.12	是	是

病例编号	性别	年龄	眼别	眼底情况	术前BCVA	术后BCVA	术后MH闭合	术后视网膜复位
1	女	57	左眼	下方周边部圆孔及马蹄形裂孔，合并MH	0.05	0.3	是	是
2	男	63	右眼	上方长条形变性区两端裂孔，合并MH	手动	0.1	否	是
3	女	44	左眼	先发生鼻下方大马蹄形裂孔，其后发生MH	手动	0.8	是	是
4	男	43	左眼	上方周边马蹄孔，下方周边圆孔，MH合并脉络膜脱离	0.1	0.05	否	是
5	男	34	右眼	上方周边变性区两端裂孔，下方多发裂孔，合并MH	手动	0.4	是	是
6	女	64	右眼	上方变性区一端马蹄形裂孔，合并MH	光感	0.05	是	是
7	男	38	右眼	颞侧周边部巨大视网膜裂孔，合并MH	手动	0.02	是	是
8	女	52	右眼	上方变性区一端马蹄形裂孔，合并MH	手动	0.2	是	是
9	女	59	左眼	周边变性区多发裂孔，合并MH，合并脉络膜脱离	0.01	0.05	是	是
10	男	30	右眼	上方睫状上皮脱离，下方多发裂孔，合并MH	手动	0.02	是	是
11	男	53	左眼	颞上周边部视网膜裂孔，合并MH，合并脉络膜脱离	0.06	0.15	是	是
12	男	59	左眼	先发生颞上马蹄形裂孔，其后发生MH	0.05	0.1	是	是
13	女	55	右眼	周边变性区两个裂孔，合并MH	0.01	0.3	是	是
14	男	49	左眼	颞上，颞下长条形变性区一端撕裂孔，合并MH	指数	0.05	是	是
15	女	65	右眼	颞侧周边部视网膜裂孔，合并MH	0.02	0.02	是	是
16	男	63	右眼	颞侧周边多个马蹄形裂孔，下方多个干孔，合并MH	手动	0.3	是	是
17	女	67	左眼	颞上马蹄形裂孔，合并MH	0.01	0.1	是	是
18	男	51	左眼	颞上条形变性区内裂孔，合并MH	0.05	0.2	是	否
19	男	42	左眼	颞上锯齿缘离断，鼻下裂孔，MH合并脉络膜脱离	0.07	0.1	是	是
20	女	47	右眼	颞上马蹄形裂孔，合并MH	0.06	0.12	是	是

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