Comparison of One-stage and Two-stage Surgery for Macular Hole Retinal Detachment in Highly Myopic Eyes

Purpose: To compare the surgical outcomes of one-stage and two-stage vitrectomy for macular hole retinal detachment (MHRD) in highly myopic eyes, focusing on macular hole (MH) closure and retinal reattachment.Methods: This retrospective study included 17 eyes of 17 patients with high myopia who underwent surgery for MHRD.Ten eyes underwent conventional one-stage pars plana vitrectomy with internal limiting membrane (ILM) peeling or inverted flap (Group 1).Seven eyes underwent a two-stage procedure (Group 2): initial vitrectomy with silicone oil (SO) tamponade to reattach the retina, followed by SO removal and an inverted ILM flap technique 1-2 weeks later.MH closure, retinal reattachment, and best-corrected visual acuity (BCVA) were analyzed.Results: BCVA improved significantly in both groups.In Group 1, mean BCVA improved from 2.00 ± 0.10 preoperatively to 1.09 ± 0.16 at final follow-up (p = 0.002).In Group 2, mean BCVA improved from 2.13 ± 0.11 to 1.00 ± 0.13 (p = 0.016).Final BCVA did not differ significantly between the two groups (p = 0.622).Notably, MH closure was achieved in only half of the eyes (50.0%, 5/10) in Group 1, whereas all eyes (100.0%,7/7) in Group 2 achieved definitive closure, demonstrating a statistically significant advantage for the two-stage approach (p = 0.044).Retinal detachment recurred in three eyes of Group 1 after the initial surgery, and two of these eyes showed persistent inferior retinal detachment at final follow-up.No severe complications such as endophthalmitis were observed.Conclusions: The two-stage procedure resulted in significantly higher MH closure rates.These findings suggest that staged surgery may provide superior structural stability and improved surgical precision, particularly in cases where ILM peeling proves challenging or for novice surgeons.Prospective studies with larger cohorts and standardized surgical protocols are needed to confirm these findings.