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Objective@#To observe the clinical efficacy of digital 3D heads-up display viewing system(3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).@*Methods@#A retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.@*Results@#The fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P<0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.@*Conclusions@#3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.
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Objective To observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).Methods A retrospective,consecutive case series.From October 2018 to May 2019,Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study.There were 7 males and 12 females,with the mean age of 54.47± 11.38 years.The average axial length was 30.40±2.30 mm,the mean logMAR BCVA was 0.56±0.31,the mean central foveal thickness (CFT)was 317.80± 151.9.32 μm,the mean max retinal thickness (maxRT) was 556.7 ± 143.7 μm.All the surgeries performed combined with 3D viewing system with iOCT.The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange.Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not.The average follow-up was 4.2 ± 1.4 months.All the patients were on regular follow-up to document the changes on BCVA,anatomical changes in macula,CFT and maxRT.Paired t test was used to compare BCVA,CFT and maxRT before and after surgery.Results The fine images of macula were clearly shown on the 3D viewing system in all eyes.The electronic green filter enhanced the contrast sensitivity of ICG stained images.Clear images of macula were captured by iOCT in all eyes.The average surgical time was 35.5± 8.2 min.On the last follow-up,16 of 19 eyes with MF resolved.The mean CFT was 178.5 ± 103.5 μm,the maxRT was 341.8 ± 83.8.16 μm,and the mean logMAR BCVA was 0.35 ± 0.22.The differences of CFT,maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181,7.154,5.129;P＜ 0.001).Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering.There was no complication associated with the 3D viewing system.Conclnsions 3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia,iOCT can detect the minimal invisible full thickness macular hole during surgery.Both may contribute to improved MF closure rate and BCVA.
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Objective To observe the efficacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF).Methods This is a retrospective case study.A total of 35 MF patients (36 eyes) were enrolled in this study.There were 5 males (5 eyes) and 30 females (31 eyes),with an average age of (60.13 ± 10.00) years.All patients were examined for best corrected visual acuity (BCVA),diopter,optical coherence tomography (OCT) and axial length.The patients were divided into a MF group (group A,10 eyes),MF with foveal detachment group (group B,12 eyes) and MF with lamellar macular hole group (group C,14 eyes) according to the OCT characteristics.There was no difference of age,gender,spherical equivalent refraction and axial length among 3 groups (F=0.020,0.624,0.009,0.195;P＞0.05).There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100,41.790;P＜ 0.05).All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade.The follow-up was more than one year.The BCVA and macular structure at the final follow-up were analyzed.The efficacy between 3 forms of MF was compared.Results At the final follow-up,the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm,which were significantly improved compared with preoperative measurements (t=5.984,5.113;P＜0.001).MF was resolved in 33 eyes.In group A,B and C,the logMAR BCVA were 0.13 ± 0.10,0.73±0.33 and 0.38± 0.52,respectively;CFT was (222.40± 57.16),(212.50 ± 150.45),(206.67 ± 55.97) μm,respectively;MF was resolved in 10,11 and 12 eyes,respectively;complete ellipsoid was observe in 8,2 and 12 eyes.The logMAR BCVA (F=6.750,P=0.003) and the rate of complete ellipsoid (x2=18.590,P＜0.001) in group B was lower than group A and C,the differences were significant.There was no difference of CFT (F=0.068,P=0.935) and the rate of MF resolving (x2=1.558,P=0.459) among the three groups.One eye (1/14) in group C suffered from full layer macular hole.Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis.The macular structures and BCVA are worst in eyes with foveal detachment.
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Objective To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes,and to analyze factors affecting the MH closure rate.Methods This is a retrospective case study.21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study.All eyes were examined for best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,indirect ophthalmoscope,A and/or B-scan ultrasound,optical coherence tomography and visual electrophysiological examination.The BCVA was ranged from finger counting to 0.2.The axial length (AL) was ranged from 26.00 to 31.00 mm,with an average of 27.47 mm.Among 22 eyes,AL was between 26.00 mm to 27.00 mm in 9 eyes,27.10 mm to 28.00 mm in 5 eyes,28.10 mm to 29.00 mm in 3 eyes,29.10 mm to 30.00 mm in 3 eyes,and longer than 30.00 mm in 2 eyes.The diameter of MH was ranged from 227 μm to 597 μm and with an average of 432 μm.Among them,the minimum diameter was between 200 μm to 400 μm in 4 eyes,401 μm to 450 μm in 13 eyes,451 μm to 500 μm in 3 eyes,501 μm to 600 μm in 2 eyes.All the eyes were treated with PPV combined with ILMP surgery.The average follow-up time was 17 months after surgery.The efficacy was determined at the final follow up,including the MH closure,the state of macular retinoschisis and the BCVA.MH closure rate with different MH diameters and different AL were compared and analyzed.Results During the final followup,MH were fully closed in 17 eyes (77.3％),bridge-closed in 4 eyes (18.2％) and not closed in 1 eye (4.5％).Retinoschisis was resolved in 19 eyes (86.4％),partially resolved in 2 eyes (9.1％) and not changed in 1 eye (4.4％).MH with smaller diameter had higher MH closure rate (x2=12.036,P=0.032).MH with longer AL had lower MH closure rate (x2=16.095,P=0.003).The final BCVA was ranged from finger counting to 0.25.Among 22 eyes,BCVA or metamorphopsia were improved in 9 eyes (40.9％),stable in 8 eyes (36.4％).BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7％).Conclusions PPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes.After surgery,MH was closed and retinoschisis was resolved in most patients.The major factors affect the MH closure were the minimum diameter of MH and AL.
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Objective To observe the clinical effects of vitreoretinal surgery for myopic foveoschisis,evaluate the visual prognostic factors.Methods Twenty-seven eyes of 23 patients with myopic foveoschisis underwent vitreoretinal surgery were analyzed retrospectively. All the patients had undergone the examinations of best corrected visual acuity (BCVA),intraocular pressure,slit lamp microscope,direct ophthalmoscope,binocular indirect ophthalmoscope, A or B ultrasonic scan and optical coherence tomography (OCT).Follow-up duration varied from 6 to 36 months,with the mean of (19.4± 10.03)months.The visual acuity,retinal reattachment and the complications were observed.Logistic regression analysis was performed to predict the prognosis of visual acuity.Results Twenty-one eyes (77.78％) were anatomically reattached, six eyes (22.22％) were not anatomically reattached. Postoperative BCVA improved in 24 eyes (88.89％),reduced or remained unchanged in three eyes (11.11％). No ocular complications such as fundus hemorrhage,low or high intraocular pressure,endophthalmitis were found.The preoperative BCVA (OR =9.11,P =0.007),axial length (OR =0.31, P =0.038) and the photoreceptor inner and outer segment (IS/OS) junction line continuity (OR=4.32,P=0.001) are closely related to visual prognosis.Conclusions Vitreoretinal surgery is an effective approach to treat myopic foveoschisis with both anatomical and visual improvement.The preoperative BCVA,axial length and IS/OS line continuity are closely related to visual prognosis.