Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy.

AIM: To report the long-term outcome of posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic myopic foveoschisis (MF). METHODS: The records of 27 patients (44 eyes) treated with posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic MF were retrospectively reviewed. The best-corrected visual acuity (BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings and complications were analyzed. RESULTS: Forty-four eyes of 27 patients were included in this study. The follow-up period was 47.98±18.23mo (24-83mo). The mean preoperative BCVA (logMAR) was 1.13±0.63, and the mean postoperative BCVA was 0.30±0.33 at the last visit. There showed a significant improvement in BCVA postoperatively (P<0.001). Postoperative BCVA in 41 eyes (93%) was improved compared with the preoperative one. Forty-two eyes (95.45%) got total resolution of the MF after surgery. The remaining two eyes (4.55%) got partial resolution of foveoschisis. The preoperative foveal thickness was 610.45±217.11 µm and the postoperative foveal thickness at the last visit was significantly reduced to 177.64±55.40 µm (P<0.001). The preoperative axial length was 29.60±1.71 mm, and the postoperative axial length was 29.74±1.81 mm at the last visit. There was no significant increase in axial length within 47.98±18.23mo of follow-up (P=0.562). There was no recurrence of foveoschisis or occurrence of full-thickness macular hole during the whole follow-up period. CONCLUSION: For pathologic MF, PSR followed by vitrectomy is an effective procedure to improve the visual acuity and the anatomical structure of macula. It can also stabilize the axial length for a long time.

Outcome of scleral buckling with or without gas tamponade for recurrent retinal detachment in post-vitrectomy eyes.

BACKGROUND: Treatment of recurrent retinal detachment (re-RD) following vitrectomy (post-gas/air tamponade and post-silicone oil removal) is challenging. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when compared with scleral buckling (SB). The purpose of this study is to report anatomical and functional outcomes of SB with or without gas tamponade in eyes with recurrent retinal detachment (re-RD) that previously underwent PPV at least once. METHODS: We retrospectively reviewed the medical records of 14 patients (14 eyes) who underwent PPV at least once and were treated with SB after re-RD. Preoperative characteristics, intraoperative complications, and postoperative data were assessed. The final anatomical and functional outcomes were analyzed. RESULTS: The original PPV was performed for primary rhegmatogenous retinal detachment in 11 eyes, macular hole retinal detachment in 2 eyes, and myopic foveoschisis in 1 eye. Previously, 3 eyes underwent one PPV with gas tamponade, and the remaining 11 (79%) eyes underwent 2-5 operations. Seven eyes underwent the procedure with gas injection. At the last follow-up, 13 eyes achieved total retinal attachment and 1 eye had re-RD. The postoperative intraocular pressure was within the normal range, except in 1 eye (6 mmHg). The finest postoperative best-corrected visual acuity (BCVA) was 20/25. There was a significant improvement in BCVA from 20/160 ± 20/63 at baseline to 20/80 ± 20/50 at the last visit in the 13 successfully treated eyes (P = 0.025). CONCLUSIONS: SB can be effective for re-RD after PPV in specific cases.

Comparison of fovea-sparing and non-internal limiting membrane peeling for retinoschisis with foveal detachment in highly myopic eyes.

PURPOSE: To compare the visual and anatomical outcomes of two different treatment strategies (non-internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling) for retinoschisis with foveal detachment (FD) in highly myopic eyes. DESIGN: A retrospective cohort study. METHODS: Ninety-five eyes from 92 highly myopic patients with retinoschisis with FD were divided into two groups, including 44 eyes from 43 patients who received 23-gauge, 3-port vitrectomy without ILM peeling (group A) and 51 eyes from 49 patients who received vitrectomy with fovea-sparing ILM peeling (group B). All eyes also underwent cataract surgery. RESULTS: There were no significant differences between the two groups in terms of sex, age, diopters, axial length (AL), or central foveal thickness (CFT) before surgery (P > 0.05). One month after surgery, foveoschisis and FD were resolved in 74.47% of the eyes in group B and in only 12.50% of those in group A. Six months after surgery, foveoschisis and FD were resolved in 96.08% of the eyes in group B and in only 72.73% of those in group A (P < 0.05). There were no significant differences between the two groups in terms of BCVA 6 months after surgery. The postoperative complication was macular holes, which were found in seven eyes (15.90%) in group A and in one eye (1.96%) in group B (P < 0.05). CONCLUSION: Highly myopic eyes with FD that underwent fovea-sparing ILM peeling appeared to obtain a better anatomical outcome than those that did not undergo non-ILM peeling. The two procedures obtained similar results in terms of visual function.

Application of optical coherence tomography angiography in assessment of posterior scleral reinforcement for pathologic myopia.

AIM: To investigate the effect of posterior scleral reinforcement (PSR) on circulation of pathologic myopia eyes with posterior staphyloma by optical coherence tomography angiography (OCTA). METHODS: The study included 30 pathologic myopia eyes with posterior staphyloma which underwent PSR (PSR group) for 6 to 18mo ago, and 30 age and myopia matched eyes without PSR surgery as control group. Macular, choriocapillaris and radial peripapillary capillary (RPC) flow density were measured by OCTA, and the measurements were compared between groups. RESULTS: OCTA found no significant differences in macular flow density between PSR and control groups. For the superficial flow, whole enface flow density (WED), fovea density (FD), and parafoveal density (PD) were 46.55%±5.19% vs 47.29%±4.12% (P=0.542), 31.45%±6.35% vs 31.17%±4.48% (P=0.841), and 48.82%±5.66% vs 49.21%±4.15% (P=0.756) in PSR and control groups, respectively. For the deep flow, WED, FD, and PD were 52.07%±5.78% vs 53.95%±4.62% (P=0.168), 29.62%±6.55% vs 29.50%±6.38% (P=0.940), and 56.93%±6.17% vs 58.15%±5.13% (P=0.407) in PSR and control groups, respectively. The choriocapillary flow density was 61.18±3.25% in PSR group vs 60.88%±2.56% in control group (P=0.692). Also, OCTA found no significant differences in RPCs flow density between PSR and control groups. The optic disc WED, inside disc flow density and peripapillary flow density were 48.47%±4.77% vs 48.11%±4.57% (P=0.813), 45.47%±11.44% vs 46.68%±9.02% (P=0.709), 54.32%±5.29% vs 52.47%±6.62% (P=0.349) in PSR and control groups, respectively. CONCLUSION: OCTA provides a non-invasive and quantitative approach for monitoring macular and papillary blood flow in pathologic myopia. PSR can not improve but may maintain the circulation of pathologic myopia eyes with posterior staphyloma.

VITRECTOMY WITHOUT INNER LIMITING MEMBRANE PEELING FOR MACULAR RETINOSCHISIS IN HIGHLY MYOPIC EYES.

PURPOSE: To determine if it is necessary to peel inner limiting membrane during vitrectomy for macular retinoschisis in highly myopic eyes. METHODS: This retrospective noncomparative interventional case series included 112 eyes of 84 patients with myopic foveoschisis who were treated by 23-gauge 3-port pars plana vitrectomy. During vitrectomy, triamcinolone acetonide was injected into the vitreous cavity to visualize the vitreous. The inner limiting membrane was not peeled, but the posterior hyaloid membrane was removed from the macular surface with active suction or a flute needle. A fluid-gas exchange was carried out using 16% perfluoropropane gas. RESULTS: A total of 106 eyes (95%) exhibited collapse of the foveoschismatic intermediary zone after surgery. Best-corrected visual acuity at baseline and at the end of the follow-up did not differ significantly (1.06 ± 0.74 logarithm of the minimum angle of resolution versus 0.92 ± 0.56 logarithm of the minimum angle of resolution, P = 0.18). An improvement in best-corrected visual acuity of greater than 2 lines was achieved in 84 eyes (75%). A macular hole with retinal detachment was found in 6 eyes (5%) 1 to 8 months after surgery. Intraoperatively, all 112 eyes exhibited vitreous liquefaction. The posterior hyaloid membranes were tightly adherent to the posterior retinal surface and vessels except for 1 eye that had a complete posterior vitreous detachment. There were no or only a very small amount of triamcinolone acetonide particles attached to the surface of posterior retina in 38 eyes, which seemed that a completely posterior vitreous detachment had happened. But these membranes on the surface of the posterior retina can be removed easily, which indicated these membranes were posterior hyaloid membranes instead of internal limiting membranes. CONCLUSION: In the treatment of macular retinoschisis in highly myopic eyes, vitrectomy associated with posterior hyaloid membranes peeling may achieve successful anatomical results. Internal limiting membrane peeling seems unnecessary.

Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia.

PURPOSE: To evaluate the effect of surgical posterior scleral reinforcement in extremely myopic patients (axial length ≥30 mm) with myopic foveoschisis. METHODS: The retrospective interventional case series study included patients with an axial length ≥30 mm, posterior scleral staphyloma, and myopic foveoschisis, who were treated either by posterior scleral reinforcement and 23-gauge 3-port pars plana vitrectomy (posterior scleral reinforcement group) or by vitrectomy (vitrectomy group) alone. All eyes additionally underwent cataract surgery. RESULTS: The study included 28 patients (28 eyes) with no significant (all P > 0.05) difference between the posterior scleral reinforcement group (n = 14) and the vitrectomy group (n = 14) in age, refractive error, axial length, and preoperative best-corrected visual acuity (BCVA). In addition to posterior scleral staphyloma and foveoschisis, a macular hole, a macular hole-associated retinal detachment, and a macular detachment without macular hole were present in three eyes, five eyes, and one eye, respectively in the study group and in three eyes, three eyes, and six eyes, respectively in the control group. In the study group, BCVA was significantly better after surgery than at baseline (P = 0.005) with an improvement in BCVA in 13 eyes, whereas BCVA was unchanged in 1 eye. In the control group, BCVA at baseline and at the end of follow-up did not differ significantly (P = 0.22). Gain in BCVA was marginally significantly higher in the study group than that in the control group (improvement by 0.69 ± 0.76 logMAR vs. 0.19 ± 0.54 logMAR; P = 0.05). The number of eyes with any improvement in BCVA (13 [93%] eyes vs. 11 [79%] eyes; P = 0.289) did not differ between both groups; an improvement in BCVA by more than 2 lines (10 [71%] eyes vs. 3 [21%] eyes; P = 0.009) was significantly higher in the study group than that in the control group. Anatomical success (defined as closure of macular holes and collapse of the foveoschisis) was achieved earlier in the study group (3.7 ± 3.2 months vs. 6.2 ± 3.0 months; P = 0.04). CONCLUSION: Posterior scleral reinforcement in association with vitrectomy, as compared with vitrectomy alone, was associated with a higher improvement in visual acuity in extremely myopic eyes with foveoschisis.

[The pilot study of intravitreal injection of triamcinolone acetonide for treatment of retinal detachment with choroidal detachment].

OBJECTIVE: To evaluate the efficiency and safety of intravitreal injection of triamcinolone acetonide for treatment of retinal detachment with choroidal detachment. METHODS: 13 the patients (13 eyes) of retinal detachment with choroidal detachment were chosen and triamcinolone acetonide 0.1 ml (4 mg) were administrated via intravitreal injection through pars plana. The therapeutic effects on uveitis and choroidal detachment was analyzed. The retinal reattachment surgery was performed five to ten days after the injection. RESULTS: all 13 patients receiving triamcinolone acetonide demonstrated alleviated uveitis to some degree. The rate of retinal holes detection increased from 2/13 pre-injection to 7/13 post-operation. Choroidal detachment disappeared in most of cases within 10 days triamcinolone acetonide injection. Five eyes underwent scleral buckling, 6 eyes underwent with vitrectomy, and 2 patients abandoned surgery. The average follow up after surgery was 4 and half months. All eyes received with triamcinolone acetonide injection and surgery had retinal reattached successfully and no side effects were detected. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide was an effective and safe method to treat choroidal detachment and alleviate uveitis. The injection simplified surgery procedure and improve the success rate of retinal detachment.