ABSTRACT
Objective To observe the efficacy ofvitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).Methods Prospective and non-randomized concurrent control study.A total of 35 MF patients (35 eyes) were enrolled in this study.The patients were divided into 2 groups according to surgery,including group A (18 eyes) and group B (17 eyes),all received vitrectomy combined with ILM peeling,but group A also received scleral shortening.The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR).Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical,France).The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg,Germany).Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult,Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460),AL (t=1.520),diopter (t=0.020),logMAR BCVA (t=-2.280),MxFT (Z=-4.179) and b-wave ERG amplitude (Z=-0.198).The changes of BCVA,AL,MxFT and b wave amplitude were followed-up for 3-12 months.Results At the last follow-up,the height of MF was decreased in 18 eyes of group A,and MF was completely disappeared in 4 eyes.The logMAR BCVA (t=7.272,5.951),MxFT (Z=-3.724,-3.622) and b-wave ERG amplitude (Z=-3.223,-3.243) in both groups A and B were statistically improved (P=0.000,0.000,0.000,0.000,0.001,0.001) compared to pre-operational results.There was significant difference of logMAR BCVA (t=-2.280) and MxFT (Z=-4.179) between the two groups (P=0.029,0.000).But there was no significant difference in the amplitude of b-wave (Z=-0.198,P=0.843).The AL in group A was shortened after surgery,the difference was statistically significant (t=10.017,P=0.000).During the follow-up,there was no ocular hemorrhage,endophthalmitis and other complications.Conclusion PPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients,and gain relative normal anatomical structure of the fovea,thus improve the vision.
ABSTRACT
Objective To observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy (MTM) after vitrectomy.Methods It was a retrospective case series study.Forty-seven consecutive patients (47 eyes) diagnosed with MTM were studied between January 2010 and May 2014.There were 38 females (38 eyes) and 9 male (9 eyes),mean age was (65.13±6.98) years,mean axial length was (29.23±1.77) mm.The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography (OCT),including macular retinoschisis only group (MRS group,18 eyes),foveal retinal detachment group (FD group,13 eyes) and full-thickness macular hole group (MH group,16 eyes).All the eyes underwent minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA),intraocular pressure,axial length,A or B-ultrasonography,fundus photography,OCT and microperimetry examinations.The average logMAR BCVA of 47 eyes was 1.43±0.52.The center retinal thickness (CRT) of eyes in MRS and FD group was (528.45± 167.61) μm.All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling.The mean follow-up period was 23.4 months.The changes of logMAR BCVA,microperimetry and macular microstructural were observed.Results At the final follow-up,the logMAR BCVA of 47 eyes was 0.86 ± 0.42,which improved compared with the preoperative vision (t=7.36,P＜ 0.001).The mean CRT of eyes in MRS and FD group was (250.90 ± 91.81) μm,which improved compared with the preoperative CRT (t=8.17,P＜0.001).In MRS group,the retina was attached in 18 eyes.In FD group,the retina was attached in 11 eyes,MH was observed in 2 eyes.In MH group,recurrent retinal detachment was observed in 1 eye.The differences of logMAR BCVA and retinal sensitivity among MRS,FD and MH groups were significant (x2 =6.38,11.08;P=0.030,0.004).Conclusion The macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.
ABSTRACT
Treatment of macular hole associated retinal detachment in high myopia has progressively evolved over the years,including the scleral buckling,simple intravitreal gas injection,pars plana vitrectomy (PPV),PPV combined with internal limiting membrane (ILM) peeling or transplantation and so on.Simple vitreous gas injection is less traumatic and good for the patients with small holes and localized retinal detachment.PPV combined with ILM peeling can achieve better treatment effects for small holes with wide retinal detachment.But for large holes with wide retinal detachment,PPV combined with ILM transplantation is necessary to improve the macular holes closure rate.If the ILM has been peeled before,the lens capsule could be a nice substitute for ILM.The scleral surgery can solve the problem of posterior scleral staphyloma and effectively control the elongation of the axial length.However,there is still no one surgery could deal with all the problems of high myopia,we should consider all the circumstances like the size of the macular hole and the range of the retinal detachment to choose the best individualized therapy.
ABSTRACT
Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most vision-threatening diseases associated with macular retinal schisis and macular holes.To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair.However,there are many controversial issues in the efficacy of the surgerical procedures including gas injection,scleral buckling and vitrectomy.How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.