| Extreme myopia is usually defined as a spherical equivalent greater than -10.0D, which is often associated with progressive and excessive elongation of the eyeball resulting types of breaks and retinal detachment. The clinical data were summarized in order to investigate characteristics, surgical outcomes and the causes of the failure and supply protective and therapeutic methods to clinical works.In the study, 45 patients(45 eyes) diagnosed as retinal detachment in extreme myopia(spherical equivalent>10D,axis oculi>28mm) ,excluding injury, no lens, geneogenous diseases, tractional and exudative retinal detachment were selected in our hospital from Jan 2006 to Dec 2008.There were 9 males(9 eyes) and 36 females(36 eyes).The age ranged from 18 to 80 years old.All the patients involved unilateral retinal detachment(26 right eyes,19 left eyes). The patients had a spherical equivalent from -10.00D to -24.50D.Following ophthalmic examinations were proceeded:tonometr, B–scan. direct and indirect ophthalmoscope,visual acuity and corrected visual acuity,three-mirror contact lens,type of break and the presence of proliferative vitreoretinopathy . PVR was graded using the classification of the 1983 Retinal Termindogy Committee. The data were summarized to analyze the character of the age, spherical equivalent, outcome of the vitrectomy, and the retinal reattachment.The results of the study showed that, there were 9 males(9 eyes) and 36 females(36 eyes),and the age under 30 were 24 patients(15.6%),from 30 to 60 were 14patients (31.1%),greater than 60 were 24 patients (53.3%).The incidence of retinal detachment in 60 or more years old group was greater than other groups, and incidence rate of female was significantly higher than male. Among 45 eyes, 13 eyes occurred macular holes alone, 15 eyes suffered with macular holes and other breaks simultaneously, 17 eyes involved other breaks. We did not find any break in 5 eyes, but we all found macular holes during the surgery. In this study, the macular hole accounted for the highest proportion. We found 28 macular holes in 45 patients (62.2%) and 23 macular holes in 24 patients whose age more than 60. Increased with age, the break of macular holes were greater than other break. (x2=26.1165,p<0.05). There were 5 eyes graded PVR gade B , 7 eyes were PVR gade C1, 9 eyes were PVR gade C2, 11 eyes were PVR gade C3,and 13 eyes were PVR gade D or worse.Vitrectomy combined with combined with silicone oil or gas is an effective treatment for retinal detachment in extreme myopia. In our study, 41 eyes achieved anatomical success after the first operation .The frequency of the retinal reattachment was 91.1%.(There were 2 eyes with silicone oil dependent eyes ,silicone oil has not been removed for 2 years follow-up,they all are senior women)There were 4 cases failed and performed the second operation. (There were 1 eyes with silicone oil dependent eyes ,silicone oil has not been removed for 1 years follow-up). The visual acuity improved in 23 eyes after the operation, and the visual acuity of 0.01 or better was achieved in 26 cases.Conclusions: The patients undergo retinal detachment in extreme myopia usually associated with macular hole which highly happened on the female aging more than 60 years old .Vitrectomy is an effective treatment for retinal detachment in extreme myopia combined with macular hole, but few patients perform subsequent vitrectomy as a result of the redetachment. The leading cause of failure after operation was formation of macular epiretinal membrane,reopening of macular white hole,undetected original retinal breaks or reopening of original breaks , formation of new retinal breaks. The patients with extreme myopia should examine eyeground carefully and regularly, and increase follow-up times to the retinal degeneration without any obvious symptom.
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