The Importance of Posterior Hyaloid Removal in a Case of Vitrectomy for Floaters in High Myopia.

A 61-year-old Malaysian Chinese man who has high myopia complained of both eye floaters. Spectral-domain optical coherence tomography (SD-OCT) of the macula showed bilateral posterior staphyloma with right eye (RE) foveoschisis without macula detachment, which had been stable for a seven-year follow-up. When bilateral YAG laser vitreolysis could not alleviate his symptoms, he underwent pars plana vitrectomy with the inducement of posterior vitreous detachment, first in the left eye, followed by the RE one month later. The best-corrected visual acuity for both eyes was 6/6, N5 two months postoperatively, and he was asymptomatic for floaters. However, six months postoperatively, he complained of metamorphopsia and worsening RE vision. Repeat OCT showed worsening of the foveoschisis bilaterally with left foveal detachment. The patient had to undergo a repeat vitrectomy with peeling of the internal limiting membrane (ILM) in bilateral eyes, which successfully restored his foveal architecture and alleviated his symptoms. This article highlights theimportance of preoperative OCT assessment of the fovea in patients undergoing vitrectomy for floaters, as staining and complete removal of posterior hyaloid with ILM peeling during vitrectomy may mitigate the progression of foveoschisis after core vitrectomy for floaters in myopic patients.

Internal limiting membrane peeling combined with silicone oil or air tamponade for highly myopic foveoschisis.

AIM: To compare the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) and silicone oil or sterile air tamponade for the treatment of myopic foveoschisis (MF) in highly myopic eyes. METHODS: This retrospective study included 48 myopic eyes of 40 patients with MF and axial lengths (ALs) ranging from 26-32 mm treated between January 2020 and January 2022. All patients were underwent PPV combined with ILM peeling followed by sterile air or silicone oil tamponade and followed up at least 12mo. Based on the features on spectral-domain optical coherence tomography (SD-OCT), the eyes were divided into the MF-only group (Group A, n=15 eyes), MF with central foveal detachment group (Group B, n=20 eyes), and MF with lamellar macular hole group (Group C, n=13 eyes). According to AL, eyes were further divided into three groups: Group D (26.01-28.00 mm, n=12 eyes), Group E (28.01-30.00 mm, n=26 eyes), and Group F (30.01-32.00 mm, n=10 eyes). The best-corrected visual acuity (BCVA), central foveal thickness (CFT), and complications were recorded. RESULTS: The patients included 16 males and 24 females with the mean age of 56±9.82y. The BCVA and CFT improved in all groups after surgery (P<0.01), while there was no significant difference of the CFT in Group A, B, and C postoperatively (P>0.05). The intergroup differences of BCVA and CFT postoperatively were statistically significant in Group D, E, and F. Twenty eyes were injected with sterile air, and 28 eyes were injected with silicone oil for tamponade based on the AL. However, there was no statistically significant difference among Groups D, E, and F in terms of the results of sterile air or silicone oil tamponade. The mean recovery time was 5.9mo for MF patients subjected to silicone oil tamponade and 7.7mo for patients subjected to sterile air tamponade, and the difference was not statistically significant. CONCLUSION: PPV and ILM peeling combined with silicone oil or sterile air tamponade can achieve good results for MF in highly myopic eyes with ALs≤32 mm.

Novel surgical approaches for treating myopic traction maculopathy: a meta-analysis.

BACKGROUND: Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM. METHODS: To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1. RESULTS: Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group. CONCLUSION: Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary. TRIAL REGISTRATION: Retrospectively registered.

Three cases of macular retinal detachment exacerbated during follow-up with myopic foveoschisis around myopic choroidal neovascularization.

Purpose: Myopic choroidal neovascularization (CNV) and myopic traction maculopathy are major complications of pathologic myopia, and myopic foveoschisis (MF) is one of several symptoms that can be included under the general term "myopic traction maculopathy"; however, only a few cases will have MF around the myopic CNV. We report three cases with MF around myopic CNV that followed different clinical courses observed using swept-source optical coherence tomography. Observations: Case 1 was a 69-year-old woman with an axial length of 29.71 mm, myopic CNV, and MF in the left eye. One month after intravitreal injection of ranibizumab (IVR), a macular retinal detachment (RD) expanded. Vitrectomy and gas tamponade were performed during month 2; the macular RD and MF resolved gradually thereafter. Case 2 was a 54-year-old man with an axial length of 30.59 mm, myopic CNV, and MF in the right eye; after IVR, a macular RD developed and gradually expanded until month 4; the RD and MF resolved spontaneously and resolved during month 8. Case 3 was a 66-year-old woman with an axial length of 28.63 mm, myopic CNV, and MF in the left eye. A macular RD expanded 1 month after a previous vitrectomy for MF; after intravitreal injection of aflibercept, the macular RD and MF resolved gradually in month 12. In all cases, the CNV was accompanied by subretinal fluid, and two of the three cases had outer lamellar holes. Conclusion and Importance: The MF around the myopic CNV may lead to exacerbated MF and RD during follow-up, and the subretinal fluid caused by the CNV might facilitate MF progression. Since this condition is rare, further investigation of this entity is needed to determine appropriate management.

Risk Factors and Outcomes of Postoperative Macular Hole Formation after Vitrectomy for Myopic Traction Maculopathy: SCHISIS Report No. 2.

PURPOSE: To evaluate the incidence, pathogenesis, risk factors, and treatment outcomes of postoperative macular hole (MH) after pars plana vitrectomy (PPV) for myopic traction maculopathy (MTM). DESIGN: Multicenter, interventional, retrospective case series. SUBJECTS: Consecutive eyes that underwent PPV for MTM with a minimum 6-month follow-up. METHODS: We investigated the characteristics and treatment outcomes of postoperative MH after MTM surgery. MAIN OUTCOME MEASURES: Incidence, risk factors, and anatomic and visual outcomes of postoperative MH. RESULTS: We included 207 eyes (207 patients) with a mean follow-up of 25.9 months. During follow-up, 24 (11.6%) eyes developed MH (10 with concurrent MH retinal detachment); 15 eyes within 30 days (early), 4 eyes between 31 and 180 days (intermediate), and 5 eyes after 180 days (late). Logistic regression analysis revealed male gender (odds ratio [OR], 2.917; 95% confidence interval [CI], 1.198-7.100; P = 0.018), thinner preoperative choroidal thickness (OR, 0.988; 95% CI, 0.976-1.000; P = 0.048), and use of indocyanine green for internal limiting membrane peeling (OR, 2.960; 95% CI, 1.172-7.476; P = 0.022) as significant risk factors for postoperative MH. Internal limiting membrane peeling with a fovea-sparing technique tended to protect against postoperative MH, but it was not statistically significant (P = 0.096), because 1 eye still developed MH. Postoperative MHs were treated by observation (6 eyes), in-office octafluoropropane (C3F8) gas injection (7 eyes), or PPV (11 eyes). Macular hole closure was achieved in 20 eyes (83%). The hole closure rate was 67% (4/6 eyes) after observation, 71% (5/7 eyes) after C3F8 gas injection, and 91% (10/11 eyes) after PPV. However, visual outcomes were significantly worse for eyes with postoperative MH than those without (0.38 ± 0.43 vs. 0.68 ± 0.46; P = 0.002). CONCLUSIONS: Postoperative MH may occur in 11.6% of patients with MTM at any time after surgery. Retreatment resulted in relatively favorable anatomic closure but unfavorable visual outcomes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Case report: Outer lamellar macular hole and outer retinal detachment within myopic foveoschisis post-cataract surgery.

Background: This study aimed to report a case of outer lamellar macular hole and outer retinal detachment within myopic foveoschisis (MF) post-cataract surgery. Case presentation: An elderly female patient with bilateral high myopia and pre-existing myopic foveoschisis underwent uncomplicated sequential cataract surgeries 2 weeks apart. She was able to achieve a satisfactory visual outcome for her left eye with stable myopic foveoschisis and visual acuity of 6/7.5, near vision N6. However, her right eye vision remained poor postoperatively, with a visual acuity of 6/60. Macular optical coherence tomography (OCT) revealed a new right eye outer lamellar macular hole (OLMH) and outer retinal detachment (ORD) within pre-existing myopic foveoschisis. Her vision remained poor after 3 weeks of conservative management, and she was offered vitreoretinal surgical intervention with pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade. However, she refused surgical intervention, and her right vision remained stable at 6/60 over 3 months of follow-up. Conclusion: Outer lamellar macular hole and outer retinal detachment within myopic foveoschisis can occur soon after cataract surgery, which may be related to the progression of associated vitreomacular traction, and have a poor visual outcome if left untreated. Patients with high myopia should be informed of these complications as part of pre-operative counseling.

Surgical Outcomes of Myopic Foveoschisis According to the ATN Classification System.

INTRODUCTION: This study compared the surgical outcomes in eyes with myopic foveoschisis (MF) according to the recently developed ATN classification system. METHODS: This was an observational case series of 64 consecutive eyes that underwent vitrectomy for MF. Eyes were classified into severe myopic maculopathy (MM) (n = 43) and non-severe MM (n = 21) groups according to the ATN classification system. The primary outcome measures constituted best-corrected visual acuity (BCVA) and anatomical changes. RESULTS: In total, BCVA improved from 0.97 to 0.53 (P < 0.001) after surgery. The ATN score was significantly lower in the eyes with vision improvement than those without vision improvement (P < 0.001). In the subgroup, BCVA improved from 0.79 to 0.28 in the non-severe MM group (P < 0.001), and improved from 1.05 to 0.65 in the severe MM group (P = 0.001) after surgery. The non-severe MM group achieved better postoperative BCVA (P = 0.001) and were more likely to gain vision improvement (P < 0.001) after surgery compared with the severe MM group. Anatomical success was achieved in 62 of the 64 eyes (96.88%). Two eyes with anatomical failure developed full-thickness macular holes postoperatively; both were in the severe MM group. CONCLUSIONS: For patients with MF, different severity of MM based on ATN classification could lead to a significantly different prognosis after surgery. For patients with high ATN scores, the operative decision should be made cautiously for the worse anatomical and visual prognosis. ATN system is instructive in making operative proposals for MF.

On the basis of the newly developed ATN classification system, we found significant differences in postoperative visual acuity, the rate of vision improvement, and the rate of primary retinal reattachment after vitrectomy between the severe and non-severe myopic maculopathy groups in patients with myopic foveoschisis.

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.

Anatomical and visual outcomes of fovea-sparing internal limiting membrane peeling with or without inverted flap technique for myopic foveoschisis.

BACKGROUND: Vitrectomy and peeling of the internal limiting membrane (ILM) was an effective therapeutic approach for myopic foveoschisis with progressive visual loss. This study investigated the anatomical and visual outcomes of fovea-sparing ILM peeling with or without the inverted flap technique for patients with symptomatic myopic foveoschisis (MF). METHODS: We retrospectively reviewed the clinical data of patients with MF. Vitrectomy with fovea-sparing ILM peeling and air tamponade was performed in all patients. The primary outcome measures included best-corrected visual acuity (BCVA), mean macular thickness (MMT), and central foveal thickness (CFT). Depending on whether an inverted ILM flap technique was utilized, further subgroup comparisons between the inverted flap group and the non-inverted flap group were conducted. RESULTS: Twenty-six eyes of 22 patients were included. Fifteen eyes were underwent fovea-sparing ILM peeling without inverted ILM flap and 11 of the 26 eyes were treated with fovea-sparing ILM peeling and an inverted ILM flap technique. In the mean follow-up period of 10.74 ± 4.58 months, a significant improvement in BCVA was observed from 0.97 ± 0.45 logMAR to 0.58 ± 0.51 logMAR (P < 0.01), during which the BCVA of 20 eyes (76.92%) improved and remained stable in 5 eyes (19.23%). Moreover, a positive correlation was also found between the preoperative BCVA and the postoperative BCVA (r = 0.50, P = 0.01). At the last visit, the final MMT decreased from 492.69 ± 209.62 µm to 234.73 ± 86.09 µm, and the CFT reduced from 296.08 ± 209.22 µm to 138.31 ± 73.92 µm (all P < 0.01). A subgroup analysis found no significant differences in BCVA, MMT, or CFT between the inverted and non-inverted flap groups (all P > 0.05). CONCLUSION: Fovea-sparing ILM peeling with or without inverted flap technique resulted in favorable visual and anatomical outcomes for the treatment of MF. An important factor affecting the postoperative visual outcome was the preoperative visual acuity. Our study found no significant difference between the presence and absence of the inverted ILM flap.

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.

Myopic Foveoschisis Completely Resolves within 12 Months after Vitrectomy.

PURPOSE: To assess the sequence of anatomical resolution of myopic foveoschisis (MFS) after vitrectomy. DESIGN: Monocentric retrospective observational case series. SUBJECTS: The files of consecutive patients with MFS who underwent vitreoretinal surgery and were followed postoperatively for at least 6 months were reviewed. METHODS: Patients underwent pars plana vitrectomy for MFS. The central foveal thickness (CFT) was measured. The presence of a foveal involvement, and/or outer retinoschisis (ORS), with or without inner retinoschisis (IRS), and foveal detachment (FD) were analyzed. Anatomical success was defined as the resolution of foveal ORS and FD. MAIN OUTCOME MEASURES: The main outcome was the time to resolution of the different morphologic features of MFS after surgery. RESULTS: Thirty-nine eyes of 36 patients were included in the analysis. The mean follow-up was 14.8 ± 12.9 months (range, 6-84 months). Anatomical success was achieved in 82% of cases at the end of the follow-up and in > 80% of cases during the first year. The CFT was significantly decreased in 79% of cases at 3 months. Inner retinoschisis, present in 18 eyes (46%), resolved in all cases after a median time of 1 month. Foveal ORS, present in all cases, resolved in 82% of cases after a median time of 3 months. The FD, present in 23 eyes (59%), resolved in 91% of cases after a median time of 6 months. Extrafoveal ORS resolved in 59% of cases after a median time of 12 months. The mean best-corrected visual acuity significantly improved from 0.80 ± 0.64 logarithm of the minimum angle of resolution (logMAR) (Snellen Eq 20/148) to 0.48 ± 0.52 logMAR (Snellen Eq 20/70). CONCLUSIONS: Most MFS (80%) are completely resolved during the first year. The decrease in CFT and early resolution of IRS could be used as early biomarkers of surgical success.

Vitrectomy with internal limiting membrane peeling and gas tamponade for myopic foveoschisis.

BACKGROUND: We evaluated the effect of vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade for myopic foveoschisis (MF), and analysed prognosis with different gas tamponade. METHODS: Retrospective, non-randomized study. The records of patients with MF treated by vitrectomy, were reviewed. Patients were followed up postoperatively mean 16.74 months, to record changes of Best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS: Sixty-two eyes (59 patients) were analysed in total, with mean age of 55.29 ± 10.34 years, 49 females (83.1%). Foveoschisis completely resolved in all eyes at least 6 months post vitrectomy, except for two postoperative full-thickness macular holes (FTMH). Final BCVA improved significantly from 0.69 ± 0.39 to 0.44 ± 0.42 logMAR, and CFT from 502.47 ± 164.78 to 132.67 ± 52.26 µm. Patients were subdivided into three subgroups based on the different endotamponades used (C3F8, C2F6, and air). Baseline BCVA, baseline CFT and foveal detachment (FD) were not significantly different among the three groups. Eyes treated with air tamponade had better visual outcomes than eyes with C3F8 tamponade (P = 0.008). Baseline BCVA and FD were significant risk factors for postoperative BCVA (P < 0.001 and P = 0.013, respectively). CONCLUSIONS: Vitrectomy with ILM peeling and gas tamponade results in good functional and anatomic outcomes in the treatment of most MF. Good vision and no-FD pre-surgery are related with good visual prognosis. Air tamponade can provide as good visual recovery as expansive gas, and reduce postoperative complications.

Outcomes of Vitrectomy with Fovea-Sparing and Inverted ILM Flap Technique for Myopic Foveoschisis.

Surgical treatment of myopic foveoschisis (MF) can result in a macular hole in 11−17% of patients that may lead to poor visual outcomes and progression to macular hole retinal detachment. We evaluated the benefit of vitrectomy to treat MF using the inverted internal limiting membrane (ILM) flap and fovea-sparing ILM techniques. We studied 20 eyes of 20 patients (7 men, 13 women) with high MF (mean axial length, 29.3 ± 1.7 mm). MF was classified by optical coherence tomography findings: retinoschisis (7 eyes) or foveal detachment (13 eyes). Between October 2013 and June 2021, we performed vitreous surgery in all 20 patients, employing both techniques. Air tamponade was used in 4 eyes, SF6 gas in 10 eyes, and C3F8 gas in 6 eyes. All patients stayed in the face-down position for one full day postoperatively. Visual acuity and foveal contour were analyzed using optical coherence tomography before surgery and at 3 and 6 months postoperatively. LogMAR visual acuity was 0.46 before surgery, with a significant improvement at 3 months (0.34) and at 6 months (0.2) postoperatively (p = 0.024, p < 0.001, respectively). In all patients, the foveal contour showed improvement without macular hole formation after surgery. These results show that vitrectomy, performed using the inverted ILM flap and fovea-sparing ILM technique, is effective for treating MF.

Quantification of an oval optic disc in relation to myopic foveoschisis using swept-source optical coherence tomography.

BACKGROUND: To investigate the relationship between an oval optic disc and the occurrence of myopic foveoschisis (MF) using swept-source optic coherence tomography (SS-OCT). METHODS: Fifty eyes of 25 patients with unilateral MF were included in this retrospective observational study. The biometric features of the optic disc and peripapillary structures were evaluated using SS-OCT. RESULTS: The ovality index (OI) of the optic disc was significantly smaller (P = 0.003) and the optic disc tilt angle was greater (P = 0.023) in the eyes with MF than in the contralateral eyes. The optic disc tilt angle was significantly correlated with the OI (P = 0.000). Generalized estimating equation (GEE) model (linear regression) demonstrated that spherical equivalent refraction (P = 0.001), narrow macular staphyloma (P = 0.001) and the occurrence of MF (P = 0.026) were the independent factors associated with the OI. Narrow macular staphyloma was more frequent (P = 0.020) and the staphyloma was deeper (P = 0.006) in eyes with MF. GEE model (logistic regression) revealed that narrow macular staphyloma was the only independent factor related to the occurrence of MF (P = 0.013). CONCLUSIONS: An oval optic disc in eyes with MF resulted from the increased tilt around the vertical disc axis. The optic disc tilt was related to narrow macular staphyloma, which was the only independent factor associated with the occurrence of MF. The clinical relevance needs further exploration through longitudinal analysis.

A novel surgical technique of internal limiting membrane peeling for high myopic foveoschisis: a wide range of whole piece consecutive peeling without preservation of epi-fovea.

AIM: To demonstrate an improved surgical technique of whole piece consecutive internal limiting membrane (ILM) peeling without preservation of the epi-fovea to treat high myopic foveoschisis (MF). METHODS: A 23-gauge 3-port pars plana vitrectomy was performed on 16 patients with high MF. A parallel arc line along the vascular arcades was scraped out with a curved membrane scraper DSP. Next, an ILM forceps was used to catch hold of the incisal edge of the ILM flap, and the action of releasing and separating was subsequently taken toward the direction of the macular fovea. Next, the ILM forceps was used to grasp the released area, and the whole area coherent ILM peeling covering the macular fovea was implemented thereafter. Finally, the ILM was folded backwards and peeled off in the arc direction. RESULTS: At the final visit, the average central macular thickness decreased remarkably from 423.76±177.67 to 178.24±66.21 µm. The mean logarithm of the minimum angle of resolution best-corrected visual acuity of 1.37±0.59 was significantly alleviated to 0.74±0.59. CONCLUSION: The wide range of whole piece consecutive ILM peeling without preservation of the epi-fovea is proven to be effective and significantly reduced the occurrence of retinal tear and macular hole.

Vitrectomy with residual internal limiting membrane covering and autologous blood for a secondary macular hole: A case report.

BACKGROUND: Myopic foveoschisis (MF) is a common complication of pathological myopia. A macular hole (MH) usually results from the natural progression of MF and is a common complication of vitrectomy. Vitrectomy combined with residual internal limiting membrane (ILM) covering and autologous blood was effective for closing a secondary MH. CASE SUMMARY: A 52-year-old woman presented to our clinic with a complaint of blurred vision in the right eye for 7 years. Her best corrected visual acuity (BCVA) was 20/100, axial length was 25.79 mm and standard equivalent refractive error was -10.5 dioptres. Preoperative optical coherence tomography revealed foveoschisis in the right eye. Vitrectomy with fovea-sparing ILM peeling was performed. An MH developed and gradually expanded 5 mo after the initial vitrectomy. Vitrectomy with residual ILM covering and autologous blood was performed. The MH closed 3 wk after the second vitrectomy. CONCLUSION: Fovea-sparing ILM peeling can provide residual ILM for the treatment of MH secondary to vitrectomy for MF. Vitrectomy combined with residual ILM covering and autologous blood is effective for closing secondary MH and improving BCVA.

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.

Vitrectomy With Silicone Oil Tamponade and Without Internal Limiting Membrane Peeling for the Treatment of Myopic Foveoschisis With High Risk of Macular Hole Development.

Purpose: To explore the efficiency and safety of the surgical procedure of pars plana vitrectomy (PPV) with silicone oil (SO) tamponade and without internal limiting membrane (ILM) peeling for myopic foveoschisis (MF) eyes with high risk of macular hole formation. Methods: Three eyes (three patients) with MF and foveal detachment were enrolled into the study. Comprehensive preoperative ophthalmological assessments, including best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were performed on the eyes. Central foveal thickness (CFT) and thickness of continuous neurosensory retina at foveola were measured. All patients underwent PPV followed by SO tamponade and without ILM peeling. SO was removed when MF and retinal detachment were resolved. Patients were followed up postoperative at month 1, 3, 6, and 12. Results: All the three eyes achieved complete resolution of MF and foveal reattachment with an average SO tamponade period of 11.67 ± 0.58 months. The average CFT at 6 months was 91 ± 27.5 µm, hence reduced significantly from baseline at 365.3 ± 137.85 µm (P = 0.037). There was no postoperative macular hole formation despite the average preoperative sensory retina thickness of 58 ± 20.07 µm. Mean BCVA was improved from logMAR 1.43 ± 0.75 to logMAR 0.8 ± 0.75 on the last follow-up. Manageable SO-related complications were reported, including SO emulsification, ocular hypertension, and cataract. Conclusion: Vitrectomy with SO tamponade and without ILM peeling as an optional surgical protocol to treat MF is effective and safe, especially for MF eyes vulnerable to macular hole formation.

Outcomes of a new 3-D printing-assisted personalized macular buckle combined with para plana vitrectomy for myopic foveoschisis.

PURPOSE: To describe and evaluate the application of a new 3-D printing-assisted personalized macular buckle for patients with myopic foveoschisis (MFS). METHODS: Twelve eyes of 12 patients with MFS were included in this study. Preoperative MRI images were subsequently measured after marker implantation and imported into the MIMICS software for the 3-D reconstruction of a virtual model of an eyeball and a marker. The virtual eyeball model was designed according to the degree of retinoschisis, which was measured using optical coherence tomography preoperatively. A macular buckle was designed using a titanium stent, assisted by 3-D printing; furthermore, it was surgically placed in combination with pars plana vitrectomy. Visual acuity, axial length and anatomic outcomes were analysed pre- and postoperatively. RESULTS: Macular schisis in all patients was completely resolved after the surgery without any postoperative complications. The mean postoperative best corrected visual acuity (LogMAR) improved significantly from 1.21 to 0.92 during the 6-month follow-up period (p < 0.001) and reached 0.9 (p < 0.001) after 2 years. The axial length was significantly shortened during the 2 years postoperatively follow-up period (p < 0.01). The average axial lengths in all patients decreased from 30.62 mm preoperatively to 29.81 mm 1 month postoperatively and remained around 30.16 mm from 1 year after the surgery. CONCLUSION: The 3-D printing technique is useful to predict the indentation height and position of the macular buckle. The 3D-printing-assisted macular buckle, in combination with vitrectomy, is an effective, safe and accurate treatment modality for MFS.

Vitreomacular Interface Abnormalities in Myopic Foveoschisis: Correlation With Morphological Features and Outcome of Vitrectomy.

Purpose: To compare the morphologic characteristics and response to surgery of myopic foveoschisis (MF) with different patterns of vitreomacular interface abnormalities (VMIAs). Methods: In this observational case series, 158 eyes of 121 MF patients with epiretinal membrane (ERM) or vitreomacular traction (VMT) based on optical coherence tomography (OCT) were enrolled. All the eyes were divided into two groups by the pattern of VMIAs: ERM and VMT group. Sixty-one eyes underwent pars plana vitrectomy (PPV) and were followed up for at least 6 months. The morphologic characteristics based on OCT and the surgical outcome were evaluated. Outcome: ERM and VMT were found in 47.47 and 52.53% of the cases, respectively. A higher rate of foveal detachment (61.4 vs. 26.7%; p < 0.001) and a higher rate of outer lamellar macular hole (45.8 vs. 21.3%; p = 0.001) were detected in the eyes with VMT compared with those with ERM. In contrast, a lower rate of inner lamellar macular hole (28.9 vs. 60.0%; p = 0.001) was detected in the eyes with VMT compared with those with ERM. The disruption of the external limiting membrane (ELM) was more common in the eyes with VMT than in those with ERM (45.8 vs. 21.3%; p = 0.001). PPV was performed in 61 eyes with a mean follow-up time of 23.55 ± 19.92 months. After surgery, anatomical resolution was achieved in 51 eyes (83.6%). At the final visit, the mean central foveal thickness (CFT) decreased significantly from 547.83 to 118.74 µm, and the mean LogMAR BCVA improved significantly from 0.92 to 0.57. The VMT group was associated with a higher proportion of eyes with visual acuity improvement postoperatively (p = 0.02) and had more a decrease of CFT (P = 0.007) compared with the ERM group. Conclusion: In the eyes with MF, outer retinal lesions occurred more frequently in the eyes with VMT, whereas inner retinal lesions occurred more frequently in the eyes with ERM. Tangential force generated by ERM may act as a causative factor for the inner retinal lesions in MF, and inward-directed force resulting from VMT may act as a causative factor for outer retinal lesions in MF.