Pars plana vitrectomy with silicone oil tamponade as primary treatment of myopic foveoschisis with high risk for macular hole

Objective@#This small case series demonstrated pars plana vitrectomy and silicone tamponade without internal limiting membrane (ILM) peeling to be a simple, safe, and effective surgical technique for the treatment of myopic traction maculopathy (MTM).@*Methods@#This is a small case series consisting of 3 eyes with MTM. In all eyes, pars plana vitrectomy with silicone oil tamponade was performed by a single vitreoretinal surgeon. Functional and anatomic outcomes are reported.@*Results@#All 3 eyes had improved visual acuity with no noted short-term complications such as iatrogenic macular hole and retinal detachment. Although foveoschisis was only partly anatomically resolved in 2 out of the 3 cases, functional outcome, in terms of visual acuity at last visit, was satisfactory.@*Conclusion@#Vitrectomy with silicone oil tamponade without ILM peeling is a simple, effective, and safe optional surgical technique to treat MTM.

Efficacy of vitrectomy for highly myopic macular hole with or without foveoschisis / 中华眼底病杂志

Objective:To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C 3F 8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. Methods:A retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference ( P>0.05). PPV combined with ILM peeling and C 3F 8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. Results:After initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation ( P>0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month ( P=0.783, 0.358), but the difference was statistically significant at 3 months ( P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation ( P=0.687, 0.950). Conclusion:PPV combined with ILM peeling and C 3F 8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.

Outcomes of macular buckling with a T-shaped buckle for myopic tractional maculopathies associated with posterior staphyloma: An Indian experience

Purpose: To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia?associated foveoschisis (FS) and macular detachment with or without macular hole (MH). Methods: A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow?up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow?up was 11.2 months. Results: At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full?thickness macular hole?related retinal detachment was present in nine cases. Swept?source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best?corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%). Conclusion: Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

The necessity to protect against the risk of surgery-related macular hole formation in high myopia foveoschis surgery / 中华眼底病杂志

The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.

The necessity to protect against the risk of surgery-related macular hole formation in high myopia foveoschis surgery / 中华眼底病杂志

The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.

Four-year outcomes of macular buckling for traction maculopathy in highly myopic eyes / 中华眼底病杂志

Objective:To observe the long-term efficacy and safety of macular buckling (MB) in the treatment of high myopia traction maculopathy.Methods:A retrospective clinical study. From January 2014 to December 2017, 57 eyes of 57 patients with high myopia traction maculopathy who underwent MB treatment at Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. Among them, there were 15 males with 15 eyes, average age was 51.80±10.72 years; there were 42 females with 42 eyes, average age was 59.14±11.51 years. There were 21 eyes of 21 cases with highly myopic macular hole with macular detachment (MHMD), and 36 eyes in 36 cases with highly myopic foveoschisis with macular detachment (FSMD), and they were grouped accordingly. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and axial length (AL) measurements. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All patients underwent MB, either on its own or combined with vitrectomy. Patients with significant vitreous macular traction on OCT were treated with combined surgery. One, 3, 6 months and 1, 2, 3, and 4 years after the operation, the same equipment and methods before the operation were used to conduct related examinations, and the long-term efficacy and safety of the two groups of eyes were observed.Results:Before surgery, the logMAR BCVA of eyes in MHMD group and FSMD group were 1.35±0.47 and 1.17±0.59, respectively; 4 years after surgery, they were 1.02±0.49 and 0.73±0.55, respectively. The BCVA improved significantly at postoperative 4 years than preoperative in both groups ( P=0.039, 0.001). In the eyes with MHMD, the BCVA was found to be significant improved 3 years after surgery ( P=0.042). Whereas, in the eyes with FSMD, the BCVA was found to be significantly improved 3 months after surgery ( P=0.013). Macular reattachment was achieved in 100% of cases, while macular hole closure rate was achieved in 66.7% in the MHMD group. In the FSMD group, either macular reattachment rate or the foveoschisis resolution rate was 97.2%. After surgery, choroidal neovascularization was observed in 2 eyes, and 3 eyes with intraretinal cyst. Conclusion:MB may represent a safe and effective surgical option for the treatment of high myopia maculopathy.

Comparision of the clinical effects on vitrectomy with or without fovea-sparing internal limiting membrane peeling / 中华实验眼科杂志

Objective To evaluate the clinical effects of vitrectomy with or without fovea-sparing internal limiting membrane peeling on macular foveoschisis (MF) secondary to pathologic myopia.Methods A non-randomized controlled study was adopted.Twenty-three patients (25 eyes) with refractive error ≥-8.00 DS and MF either combined with foveal retinal detachment or epi-macualr membrane or lamellar macular hole.The subjects were divided into non-internal limiting membrane peeling group (11 patients / 11 eyes) who underwent triamcinolone (TA) assisted vitrectomy and fovea-sparing internal limiting membrane peeling group (12 patients/14 eyes) who underwent TA assisted vitrectomy with fovea-sparing internal limiting membrane peeling.The baseline data such as age,best corrected visual acuity (BCVA),refractive error,axial length were not significant difference between the two group.Main outcomes were BCVA,remission of MF defined by optical coherence tomographyc OCT as well as complications.This study followed the Declaration of Helsinki and this protocol was approved by Ethic Committee of Xiamen Eye Center of Xiamen University (NO.XMYKZX-2016-YWS-007).Results All patients completed follow-up for more 6 months.BCVA (LogMAR) was 0.47±0.30 in non-internal limiting membrane peeling group and 0.40-±0.33 in fovea-sparing internal limiting membrane peeling group,showing no significant difference between the two groups (t =0.66,P=0.52).Complete remission of MF was achieved in 22 eyes.The remission time in non-internal limiting membrane peeling group was 2.5 (1.8,9.3) months,and 1.0 (1.0,3.8) months in fovea-sparing internal limiting membrane peeling group,no statistical significance was obtained between the two groups (U =35.00,P =0.09).One eye had post-operative macular hole in non-internal limiting membrane peeling group,accounting for 9％,while in fovea-sparing internal limiting membrane peeling group,one eye had macular hole,accounting for 7％,and one eye had rhegmatogenous retinal detachment post-operatively,accounting for 7％.Conclusions MF can be resolved by vitrectomy while complete remission can achieved more quickly when combined with fovea-sparing internal limiting membrane peeling.

Prognostic Factors Related with Surgical Outcome of Vitrectomy in Myopic Traction Maculopathy

Comparision of the clinical effects on vitrectomy with or without fovea-sparing internal limiting membrane peeling / 中华实验眼科杂志

Objective@#To evaluate the clinical effects of vitrectomy with or without fovea-sparing internal limiting membrane peeling on macular foveoschisis (MF) secondary to pathologic myopia.@*Methods@#A non-randomized controlled study was adopted.Twenty-three patients (25 eyes) with refractive error ≥-8.00 DS and MF either combined with foveal retinal detachment or epi-macualr membrane or lamellar macular hole.The subjects were divided into non-internal limiting membrane peeling group (11 patients /11 eyes) who underwent triamcinolone (TA) assisted vitrectomy and fovea-sparing internal limiting membrane peeling group (12 patients/14 eyes) who underwent TA assisted vitrectomy with fovea-sparing internal limiting membrane peeling.The baseline data such as age, best corrected visual acuity (BCVA), refractive error, axial length were not significant difference between the two group.Main outcomes were BCVA, remission of MF defined by optical coherence tomographyc OCT as well as complications.This study followed the Declaration of Helsinki and this protocol was approved by Ethic Committee of Xiamen Eye Center of Xiamen University (NO.XMYKZX-2016-YWS-007).@*Results@#All patients completed follow-up for more 6 months.BCVA (LogMAR) was 0.47±0.30 in non-internal limiting membrane peeling group and 0.40±0.33 in fovea-sparing internal limiting membrane peeling group, showing no significant difference between the two groups (t=0.66, P=0.52). Complete remission of MF was achieved in 22 eyes.The remission time in non-internal limiting membrane peeling group was 2.5 (1.8, 9.3) months, and 1.0 (1.0, 3.8) months in fovea-sparing internal limiting membrane peeling group, no statistical significance was obtained between the two groups (U=35.00, P=0.09). One eye had post-operative macular hole in non-internal limiting membrane peeling group, accounting for 9%, while in fovea-sparing internal limiting membrane peeling group, one eye had macular hole, accounting for 7%, and one eye had rhegmatogenous retinal detachment post-operatively, accounting for 7%.@*Conclusions@#MF can be resolved by vitrectomy while complete remission can achieved more quickly when combined with fovea-sparing internal limiting membrane peeling.

Molecular characterization of a rare phenotype of X-linked retinoschisis with angle-closure glaucoma

A 11-year-old boy presented with complaints of blurred vision and on evaluation was found to have X-linked retinoschisis (XLRS) with angle-closure glaucoma. Clinical and genetic evaluation of first-degree family members was done. His brother had a milder form of XLRS with shallow anterior chamber. Topical dorzolamide 2% and timolol 0.5% were used to control intraocular pressure. Genetic analysis revealed a novel three base pair deleterious mutation (c. 375_377 del AGA) in exon-5 of the RS1 gene in three members of the family.

Foveosquisis miópica asociada al Síndrome de Straatsma / Myopic foveoschisis associated with Straatsma's syndrome

RESUMEN Este reporte describe la presentación concomitante de foveosquisis miópica y fibras de mielina en una paciente con miopía elevada. La primera puede ser un hallazgo incidental, pero no infrecuente en pacientes con miopía elevada, y causa pérdida visual central severa. La segunda es infrecuente, y en casos muy raros se presenta asociada a miopía ipsilateral y estrabismo. Ambas entidades deben incluirse en el diagnóstico diferencial de un paciente alto miope con disminución de la visión central. La tomografía de coherencia óptica es el medio auxiliar de elección(AU)

ABSTRACT This case report describes the concomitant presentation of myopic foveoschisis and myelinated retinal nerve fibers in a patient with elevated myopia. The myopic foveoschisis may be an incidental but not uncommon finding in highly myopic eyes, leading to severe central vision loss. Myelinated retinal nerve fibers are infrequent and in rarely cases they are associated with ipsilateral myopia and strabismus. Both entities should be including as differential diagnosis of central vision loss in high myopia, and optic coherence tomography is the leading as auxiliary test(AU)

Clinical effects of intravitreal perfluoropropane tamponade and laser photocoagulation for the treatment of highly myopic foveoschisis / 眼科新进展

Objective To observe and analyze the clinical outcomes of perfluoropropane (C3 Fs) injection and laser photocoagulation on myopic foveoschisis.Methods A total of 14 patients (18 eyes) diagnosed as myopic foveoschisis were enrolled in this retrospective study.All patients received intraocular tamponade of 0.5-0.7 mL C3 F8,and after 1 week,underwent macular photocoagulation.These patients were given the best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) examination for central foveal thickness (CFT) and maximal macular thickness (MMT) before and after treatment.Results OCT examination showed that the mean CFT decreased significantly from (494.00 ±454.80) iμm before treatment to (193.61 ± 97.42) μm at the last follow-up,with statistical significance (P =0.01),and the mean MMT decreased from (687.33 ± 385.15)pμn to (331.06 ± 109.31)μm at the same duration,approaching significant difference (P =0.001).The foveoschisis healed completely and partially in 14 eyes at the last follow-up,the mean CFT decreased significantly from (567.36 ±493.01) μm before treatment to (171.43 ± 90.84) μm after treatment,with statistical significance (P =0.006),and the mean MMT decreased from (744.14 ± 417.38)μm to (303.86 ± 8.62)prn at the same duration,approaching significant difference (P =0.002).Patients' BCVA before treatment was (0.94 ± 0.39) logMAR,of which 13 eyes had BCVA ＜ 0.6 logMAR,and increased to (0.92 ± 0.36) logMAR at the last follow-up,with no significant difference (P =0.78).The foveoschisis healed completely and partially in 14 eyes,and the BCVA was (1.04 ± 0.37) logMAR before treatment,up to (0.90 ± 0.34) logMAR after treatment,and the difference was not statistically significant (P =0.16).At the last follow-up,the vision of 4 eyes was increased by 2 lines and above,and unchanged in 10 eyes.All patients had no visual symptoms such as dark spots and no increase in intraocular pressure after treatment.Conclusion Intraocular C3 F8 tamponade and macular photocoagulation can be an satisfying alternative treatment for patients with myopic foveoschisis.

Analysis of phacovitrectomy with internal limiting membrane peeling to treat foveoschisis without macular hole in ultra-high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the results of phacovitrectomy with internal limiting membrane(ILM) peeling to treat foveoschisis in ultra-high myopia.METHODS: Totally 32 eyes of 32 ultra-high myopia patients with foveoschisis were selected retrospectively.The preoperative refractive errors ranged from-12.00D to-20.00D with the mean of-15.78±2.16D.The best corrected visiual acuity(BCVA) were converted to LogMAR acuity, and the average BCVA was 4.1±0.4.Conventional phacovitrectomy with ILM peeling by ICG dying were performed.Gas tamponade were performed to end the operation.The BCVA and the foveoschisis cavity were observed by 1-9mo after the surgery, with the mean of 4.5mo.RESULTS: The foveoschisis cavity of 30 eyes were healed with BCVA increased and visual distortion alleviated distinctly (94%)(t=-7.91, P<0.05).CONCLUSION: Phacovitrectomy with ILM peeling is useful in treating foveoschisis in ultra-high myopia with visual function preserving.

Temporary resolution of foveal schisis following vitrectomy with silicon oil tamponade in X‑linked retinoschisis with retinal detachment.

X‑linked retinoschisis (XLR) is an uncommon bilateral vitreoretinal dystrophy characterized by typical foveoschisis in all patients that may be associated with peripheral retinoschisis. A young male with XLR with retinal detachment in his right eye underwent 23 gauge pars plana vitrectomy with silicone oil tamponade. Postoperatively, best‑corrected visual acuity (BCVA) improved to 20/120 with an attached retina. Spectral‑domain optical coherence tomography showed macular thinning with the collapse of the schitic cavities with silicone oil in situ. Following silicone oil removal at 6 months follow‑up, the retina remained attached with a BCVA of 20/80 however the foveal schitic cavities reappeared. This unusual course has not been described previously.

Application of posterior scleral reinforcement in high myopic maculopathy / 国际眼科杂志(Guoji Yanke Zazhi)

The rate of blinding caused by high myopic maculopathy is high, vitrectomy is the most common treatment. However, the effectiveness of vitrectomy for high myopic patients who have serious posterior scleral staphyloma is not ideal. Recent years, posterior scleral reinforcement is used as a supplementary method with vitrectomy in clinical, treating for high myopic maculopathy. lt achieves a positive curative effect especially in macular foveoschisis and macular hole cases. ln this article, we introduced a review of history, current situation, material and surgery operand of scleral reinforcement. lt also makes a further discussion of its prospects used in retina surgery.

Research progress of foveoschisis in pathological myopia / 国际眼科杂志(Guoji Yanke Zazhi)

?Pathological myopia are often complicated by a series of pathological changes in fundus including foveoschisis, which can lead to visual dysfunction when processing with retinal detachment, macular hole, epiretinal membrane and vitreoretinal traction diseases. According to the current knowledge, the main mechanism of foveoschisisi might be attributed to the impaired macular structure and function caused by a variety of traction on the retinal and retina poor condition. Surgical treatments have been reported to be effective in treating foveoschisis, however, the indications and surgical procedures are still controversial. ln this article, we reviewed the clinical features, diagnosis, treatment strategies and prognosis of pathological myopia foveoschisis.

Vitrectomy combined with internal limiting membrane peeling for treating foveoschisis in high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the efficacy and safety of vitrectomy combined with internal limiting membrane ( ILM) peeling for treating foveoschisis in high myopia. METHODS:Thirty high-myopia patients (30 eyes) with foveoschisis from March 2011 to March 2013 were divided two groups: the treatment group ( 16 eyes ) was treated with vitrectomy combined with ILM peeling, and the control group (14 eyes) was treated only with vitrectomy. The foveoschisis reattachment and and best spectacle-correction were measured preoperatively and 2mo after surgery. RESULTS: The improvement of foveoschisis reattachment and best spectacle - correction in the treatment group was significantly better than those in the control group (P CONCLUSION: Vitrectomy combined with ILM peeling is a safe and effective treatment for foveoschisis in high myopia.

Alteraciones del polo posterior en la miopía degenerativa / Alterations of the posterior pole in degenerative myopia patients

La miopía degenerativa constituye una de las causas fundamentales de pérdida de la visión. Esto está relacionado con las alteraciones del polo posterior, que afectan la retina neurosensorial, el epitelio pigmentario de la retina y las capas más internas de la coroides. Su curso lento y progresivo demanda una exploración integral, con seguimiento en el tiempo y constituye un reto para el oftalmólogo. Se realizó una revisión de artículos publicados e indexados en la base de datos de PubMed que se refirieran a las características clínicas del fondo de ojo en pacientes con miopía degenerativa...

Degenerative myopia is one of the main causes of visual impairment. This is related to disorders in the posterior pole, affecting the neurosensorial retina, the retinal pigmented epithelium and the inner choroidal layers. The slow and progressive course of this condition demands comprehensive assessment and long follow-up, which is a challenging task for ophthalmologists. A review of the articles indexed in PubMed regarding the clinical characteristics of the fundus in patients with degenerative myopia was made to describe the main disorders of the posterior pole of the eyeball. ..