Imaging features of pathological myopic perivascular abnormalities and macular retinoschisis and their correlation with clinical features_Chinese Journal of Ocular Fundus Diseases

Authors：

An Guangqi , Zhang Min , Liu Pei , Lu Chenyu , Gao Wenna , Jin Xuemin ,  Du Liping

Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China Zhang Min, now is working in Department of Ophthalmology, Zhengzhou People's Hospital, Zhengzhou 450000, China;

Corresponding author：

Du Liping, Email: dulplab@live.cn

Keywords：

Myopia; Retinoschisis; Paravascular lesions; Optical coherence tomography

DOI：

10.3760/cma.j.cn511434-20240908-00346

Video：

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Objective To observe and analyze the imaging features of pathologic myopic paravascular abnormalities (PVA) and macular retinoschisis (MRS) and their relationship with clinical features. Methods A retrospective case series study. A total of 371 eyes of 224 patients with pathological myopia with PVA and/or MRS diagnosed by examination in Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University from September 2021 to December 2023 were included in the study. There were 74 eyes in 48 males and 297 eyes in 176 females. Age were 54 (49, 61) years; equivalent spherical lens (SE) was −13.375 (−18.00, −10.00) D. Axial length (AL) was 29.84 (28.27, 31.24) mm. According to the features of ultra-wide-angle sweep source optical coherence tomography, PVA morphology was divided into blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes. MRS was divided into inner layer, outer layer and mixed layer according to splitting level, and grouped accordingly. The presence of dome-shaped macula (DSM), internal and external lamellar macular hole, and full lamellar macular hole (FTMH) were recorded. According to whether PVA combined with MRS or not, the affected eyes were divided into PVA group and PVA combined with MRS group. According to whether MRS involved the fovea, the affected eyes were divided into two groups: MRS not involved the fovea group and MRS involved the fovea group. Mann-Whitney U test was used to compare age, SE and AL among different groups. Qualitative data were compared by χ² test. Results In 371 eyes, there were 120 eyes in the simple PVA group; in the MRS group, there were 251 eyes, of which 208 eyes were in the PVA combined with MRS group. There were 33, 27, 3, 14, 12, 56, 28, and 7 eyes with or without retinal detachment, choroidal neovascularization, DSM, preretinal membrane, and simple superficial detachment of neuroepithelium in inner lamina, outer lamina, and FTMH, respectively. In 328 eyes with PVA, blood vessels and paravascular microfolds, paravascular retinal cysts, paravascular retinal splits and paravascular lamellar macular holes were 151, 236, 202 and 72 eyes, respectively. There were 142 eyes with single lesion (43.29%, 142/328). There were 186 eyes with 2 or more lesions (56.71%, 186/328). There were 34 eyes in the inner MRS group, 92 eyes in the outer MRS group and 125 eyes in the mixed MRS group, respectively. It involved 155 eyes in the fovea group; 96 eyes in the fovea group were not involved. There were significant differences in the number of PVA eyes between the outer MRS group, the inner MRS group and the mixed MRS group (χ²=30.614, 28.379; P＜0.001). Compared with PVA group, PVA group combined with MRS group was more likely to have two or more PVA lesions, the difference was statistically significant (χ²=30.535, P＜0.001). Compared with the inner MRS group and mixed MRS group, the age of the simple PVA group was younger, and the age of the outer MRS group was older, and the differences were statistically significant (P＜0.05). Compared with the inner MRS group and the outer MRS group, the simple PVA group had short AL, less myopia and better optimal corrected visual acuity (BCVA), while the mixed MRS group had long AL, more myopia and worse BCVA, and the differences were statistically significant (P＜0.05). Compared with the PVA group and the inner MRS group, the fovea was more involved in the outer MRS group and the mixed MRS group, and the difference was statistically significant (χ²=3.906, 10.836; P＜0.05). Those with MRS involved in fovea were older, AL was longer, myopia was more severe, and BCVA was worse (P＜0.001). DSM-associated splits were less likely to involve macula (P＜0.001). Conclusion PVA and MRS exhibit a variety of presentations, and their imaging features correlate with clinical features.

Citation： An Guangqi, Zhang Min, Liu Pei, Lu Chenyu, Gao Wenna, Jin Xuemin, Du Liping. Imaging features of pathological myopic perivascular abnormalities and macular retinoschisis and their correlation with clinical features. Chinese Journal of Ocular Fundus Diseases, 2025, 41(2): 98-105. doi: 10.3760/cma.j.cn511434-20240908-00346 Copy

1.	纪海峰, 宋继科, 张浩, 等. 近视性视网膜劈裂研究进展[J]. 国际眼科杂志, 2021, 21(8): 1394-1398. DOI: 10.3980/j.issn.1672-5123.2021.8.17.Ji HF, Song JK, Zhang H, et al. Research progress of myopic retinoschisis[J]. Int Eye Sci, 2021, 21(8): 1394-1398. DOI: 10.3980/j.issn.1672-5123.2021.8.17.
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3.	俞佳依, 李梦涵, 贺江南, 等. 近视性黄斑区视网膜劈裂的临床特征及危险因素分析[J]. 中国临床医学, 2021, 28(6): 963-968. DOI: 10.12025/j.issn.1008-6358.2021.20211755.Yu JY, Li MH, He JN, et al. Clinical characteristics and risk factors of myopic macular retinoschisis[J]. Chin J Clin Med, 2021, 28(6): 963-968. DOI: 10.12025/j.issn.1008-6358.2021.20211755.
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5.	Hsia Y, Ho TC, Yang CH, et al. Clinical characteristics and long-term evolution of lamellar macular hole in high myopia[J/OL]. PLoS One, 2020, 15(5): e0232852[2020-05-06]. https://pubmed.ncbi.nlm.nih.gov/32374792/. DOI: 10.1371/journal.pone.0232852.
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7.	Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study[J]. Ophthalmology, 2010, 117(8): 1595-1611. DOI: 10.1016/j.ophtha.2009.11.003.
8.	Jonas JB, Jonas RA, Bikbov MM, et al. Myopia: histology, clinical features, and potential implications for the etiology of axial elongation[J/OL]. Prog Retin Eye Res, 2023, 96: 101156[2022-12-28]. https://pubmed.ncbi.nlm.nih.gov/36585290/. DOI: 10.1016/j.preteyeres.2022.101156.
9.	Gohil R, Sivaprasad S, Han LT, et al. Myopic foveoschisis: a clinical review[J]. Eye (Lond), 2015, 29(5): 593-601. DOI: 10.1038/eye.2014.311.
10.	Itakura H, Kishi S, Li D, et al. Vitreous changes in high myopia observed by swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2014, 55(3): 1447-1452. DOI: 10.1167/iovs.13-13496.
11.	Takahashi H, Tanaka N, Shinohara K, et al. Importance of paravascular vitreal adhesions for development of myopic macular retinoschisis detected by ultra-widefield OCT[J]. Ophthalmology, 2021, 128(2): 256-265. DOI: 10.1016/j.ophtha.2020.06.063.
12.	Flitcroft DI, He M, Jonas JB, et al. IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): 20-30. DOI: 10.1167/iovs.18-25957.
13.	Bringmann A, Unterlauft JD, Barth T, et al. Müller cells and astrocytes in tractional macular disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100977[2022-06-05]. https://pubmed.ncbi.nlm.nih.gov/34102317/. DOI: 10.1016/j.preteyeres.2021.100977.
14.	Takahashi H, Tanaka N, Shinohara K, et al. Ultra-widefield optical coherence tomographic imaging of posterior vitreous in eyes with high myopia[J]. Am J Ophthalmol, 2019, 206: 102-112. DOI: 10.1016/j.ajo.2019.03.011.
15.	Shinohara K, Tanaka N, Jonas JB, et al. Ultrawide-field OCT to investigate relationships between myopic macular retinoschisis and posterior staphyloma[J]. Ophthalmology, 2018, 125(10): 1575-1586. DOI: 10.1016/j.ophtha.2018.03.053.
16.	Kamal-Salah R, Morillo-Sanchez MJ, Rius-Diaz F, et al. Relationship between paravascular abnormalities and foveoschisis in highly myopic patients[J]. Eye (Lond), 2015, 29(2): 280-285. DOI: 10.1038/eye.2014.255.
17.	韩金凤, 李梦迪, 金学民, 等. 后巩膜加固术治疗伴后巩膜葡萄肿的近视性黄斑劈裂的效果[J]. 中华眼外伤职业眼病杂志, 2020, 42(4): 252-257. DOI: 10.3760/cma.j.cn116022-20191030-00329.Han JF, Li MD, Jin XM, et al. The efficacy of posterior scleral reinforcement for myopic macular retinoschisis with posterior staphyloma[J]. Chin J Ocul Traum Occupat Eye Dis, 2020, 42(4): 252-257. DOI: 10.3760/cma.j.cn116022-20191030-00329.
18.	Takahashi H, Nakao N, Shinohara K, et al. Posterior vitreous detachment and paravascular retinoschisis in highly myopic young patients detected by ultra-widefield OCT[J/OL]. Sci Rep, 2021, 11(1): 17330[2021-08-30]. https://pubmed.ncbi.nlm.nih.gov/34462477/. DOI: 10.1038/s41598-021-96783-w.
19.	Chen L, Wei Y, Zhou X, et al. Morphologic, biomechaniocal, and compositional features of the internal limiting membrane in pathologic myopic foveoschisis[J]. Invest Ophthalmol Vis Sci, 2018, 59(13): 5569-5578. DOI: 10.1167/iovs.18-24676.
20.	Tian J, Lin C, Fang Y, et al. Multimodal analysis on clinical characteristics of the advanced stage in myopic traction maculopathy[J]. Ophthalmol Ther, 2023, 12(5): 2569-2581. DOI: 10.1007/s40123-023-00745-6.
21.	Nebbioso M, Lambiase A, Gharbiya M, et al. High myopic patients with and without foveoschisis: morphological and functional characteristics[J]. Doc Ophthalmol, 2020, 141(3): 227-236. DOI: 10.1007/s10633-020-09767-y.
22.	Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800. DOI: 10.1016/s0002-9394(02)01394-6.
23.	Shimada N, Tanaka Y, Tokoro T, et al. Natural course of myopic traction maculopathy and factors associated with progression or resolution[J]. Am J Ophthalmol, 2013, 156(5): 948-957. DOI: 10.1016/j.ajo.2013.06.031.
24.	Gaucher D, Erginay A, Lecleire-Collet A, et al. Dome-shaped macula in eyes with myopic posterior staphyloma[J]. Am J Ophthalmol, 2008, 145(5): 909-914. DOI: 10.1016/j.ajo.2008.01.012.
25.	Jain M, Gopal L, Padhi TR. Dome-shaped maculopathy: a review[J]. Eye (Lond), 2021, 35(9): 2458-2467. DOI: 10.1038/s41433-021-01518-w.
26.	陈秋莹, 樊莹. 高度近视圆顶状黄斑的形态特征及常见并发症治疗[J]. 中华眼底病杂志, 2016, 32(3): 323-326. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.026.Chen QY, Fan Y. The morphological characteristics and complications treatment of dome-shaped macula in high myopia[J]. Chin J Ocul Fundus Dis, 2016, 32(3): 323-326. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.026.
27.	Kumar V, Verma S, Azad SV, et al. Dome-shaped macula-review of literature[J]. Surv Ophthalmol, 2021, 66(4): 560-571. DOI: 10.1016/j.survophthal.2020.11.002.
28.	Dai F, Li S, Wang Y, et al. Correlation between posterior staphyloma and dome-shaped macular in high myopia[J]. Retina, 2020, 40(11): 2119-2126. DOI: 10.1097/IAE.0000000000002722.
29.	Fang D, Zhang Z, Wei Y, et al. The morphological relationship between dome-shaped macula and myopic retinoschisis: a cross-sectional study of 409 highly myopic eyes[J]. Invest Ophthalmol Vis Sci, 2020, 61(3): 19. DOI: 10.1167/iovs.61.3.19.
30.	Ripa M, Motta L, Matello V, et al. Long-term results of macular buckle for MTM stage 3-4 with maculoschisis and macular detachment without and with lamellar macular hole[J]. Eur J Ophthalmol, 2024, 34(6): 1828-1836. DOI: 10.1177/11206721241234958.
31.	Parolini B, Palmieri M, Finzi A, et al. The new myopic traction maculopathy staging system[J]. Eur J Ophthalmol, 2021, 31(3): 1299-1312. DOI: 10.1177/1120672120930590.

1. 纪海峰, 宋继科, 张浩, 等. 近视性视网膜劈裂研究进展[J]. 国际眼科杂志, 2021, 21(8): 1394-1398. DOI: 10.3980/j.issn.1672-5123.2021.8.17.Ji HF, Song JK, Zhang H, et al. Research progress of myopic retinoschisis[J]. Int Eye Sci, 2021, 21(8): 1394-1398. DOI: 10.3980/j.issn.1672-5123.2021.8.17.
2. Park UC, Yoon CK, Bae K, et al. Association of retinal sensitivity with optical coherence tomography microstructure in highly myopic patients[J/OL]. Invest Ophthalmol Vis Sci, 2022, 63(11): 13[2022-06-01]. https://pubmed.ncbi.nlm.nih.gov/36255365/. DOI: 10.1167/iovs.63.11.13.
3. 俞佳依, 李梦涵, 贺江南, 等. 近视性黄斑区视网膜劈裂的临床特征及危险因素分析[J]. 中国临床医学, 2021, 28(6): 963-968. DOI: 10.12025/j.issn.1008-6358.2021.20211755.Yu JY, Li MH, He JN, et al. Clinical characteristics and risk factors of myopic macular retinoschisis[J]. Chin J Clin Med, 2021, 28(6): 963-968. DOI: 10.12025/j.issn.1008-6358.2021.20211755.
4. Hsia Y, Lee CY, Ho TC, et al. The development and evolution of lamellar macular hole in highly myopic eyes[J]. Eye (Lond), 2023, 37(6): 1170-1177. DOI: 10.1038/s41433-022-02086-3.
5. Hsia Y, Ho TC, Yang CH, et al. Clinical characteristics and long-term evolution of lamellar macular hole in high myopia[J/OL]. PLoS One, 2020, 15(5): e0232852[2020-05-06]. https://pubmed.ncbi.nlm.nih.gov/32374792/. DOI: 10.1371/journal.pone.0232852.
6. Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J/OL]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
7. Hayashi K, Ohno-Matsui K, Shimada N, et al. Long-term pattern of progression of myopic maculopathy: a natural history study[J]. Ophthalmology, 2010, 117(8): 1595-1611. DOI: 10.1016/j.ophtha.2009.11.003.
8. Jonas JB, Jonas RA, Bikbov MM, et al. Myopia: histology, clinical features, and potential implications for the etiology of axial elongation[J/OL]. Prog Retin Eye Res, 2023, 96: 101156[2022-12-28]. https://pubmed.ncbi.nlm.nih.gov/36585290/. DOI: 10.1016/j.preteyeres.2022.101156.
9. Gohil R, Sivaprasad S, Han LT, et al. Myopic foveoschisis: a clinical review[J]. Eye (Lond), 2015, 29(5): 593-601. DOI: 10.1038/eye.2014.311.
10. Itakura H, Kishi S, Li D, et al. Vitreous changes in high myopia observed by swept-source optical coherence tomography[J]. Invest Ophthalmol Vis Sci, 2014, 55(3): 1447-1452. DOI: 10.1167/iovs.13-13496.
11. Takahashi H, Tanaka N, Shinohara K, et al. Importance of paravascular vitreal adhesions for development of myopic macular retinoschisis detected by ultra-widefield OCT[J]. Ophthalmology, 2021, 128(2): 256-265. DOI: 10.1016/j.ophtha.2020.06.063.
12. Flitcroft DI, He M, Jonas JB, et al. IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): 20-30. DOI: 10.1167/iovs.18-25957.
13. Bringmann A, Unterlauft JD, Barth T, et al. Müller cells and astrocytes in tractional macular disorders[J/OL]. Prog Retin Eye Res, 2022, 86: 100977[2022-06-05]. https://pubmed.ncbi.nlm.nih.gov/34102317/. DOI: 10.1016/j.preteyeres.2021.100977.
14. Takahashi H, Tanaka N, Shinohara K, et al. Ultra-widefield optical coherence tomographic imaging of posterior vitreous in eyes with high myopia[J]. Am J Ophthalmol, 2019, 206: 102-112. DOI: 10.1016/j.ajo.2019.03.011.
15. Shinohara K, Tanaka N, Jonas JB, et al. Ultrawide-field OCT to investigate relationships between myopic macular retinoschisis and posterior staphyloma[J]. Ophthalmology, 2018, 125(10): 1575-1586. DOI: 10.1016/j.ophtha.2018.03.053.
16. Kamal-Salah R, Morillo-Sanchez MJ, Rius-Diaz F, et al. Relationship between paravascular abnormalities and foveoschisis in highly myopic patients[J]. Eye (Lond), 2015, 29(2): 280-285. DOI: 10.1038/eye.2014.255.
17. 韩金凤, 李梦迪, 金学民, 等. 后巩膜加固术治疗伴后巩膜葡萄肿的近视性黄斑劈裂的效果[J]. 中华眼外伤职业眼病杂志, 2020, 42(4): 252-257. DOI: 10.3760/cma.j.cn116022-20191030-00329.Han JF, Li MD, Jin XM, et al. The efficacy of posterior scleral reinforcement for myopic macular retinoschisis with posterior staphyloma[J]. Chin J Ocul Traum Occupat Eye Dis, 2020, 42(4): 252-257. DOI: 10.3760/cma.j.cn116022-20191030-00329.
18. Takahashi H, Nakao N, Shinohara K, et al. Posterior vitreous detachment and paravascular retinoschisis in highly myopic young patients detected by ultra-widefield OCT[J/OL]. Sci Rep, 2021, 11(1): 17330[2021-08-30]. https://pubmed.ncbi.nlm.nih.gov/34462477/. DOI: 10.1038/s41598-021-96783-w.
19. Chen L, Wei Y, Zhou X, et al. Morphologic, biomechaniocal, and compositional features of the internal limiting membrane in pathologic myopic foveoschisis[J]. Invest Ophthalmol Vis Sci, 2018, 59(13): 5569-5578. DOI: 10.1167/iovs.18-24676.
20. Tian J, Lin C, Fang Y, et al. Multimodal analysis on clinical characteristics of the advanced stage in myopic traction maculopathy[J]. Ophthalmol Ther, 2023, 12(5): 2569-2581. DOI: 10.1007/s40123-023-00745-6.
21. Nebbioso M, Lambiase A, Gharbiya M, et al. High myopic patients with and without foveoschisis: morphological and functional characteristics[J]. Doc Ophthalmol, 2020, 141(3): 227-236. DOI: 10.1007/s10633-020-09767-y.
22. Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800. DOI: 10.1016/s0002-9394(02)01394-6.
23. Shimada N, Tanaka Y, Tokoro T, et al. Natural course of myopic traction maculopathy and factors associated with progression or resolution[J]. Am J Ophthalmol, 2013, 156(5): 948-957. DOI: 10.1016/j.ajo.2013.06.031.
24. Gaucher D, Erginay A, Lecleire-Collet A, et al. Dome-shaped macula in eyes with myopic posterior staphyloma[J]. Am J Ophthalmol, 2008, 145(5): 909-914. DOI: 10.1016/j.ajo.2008.01.012.
25. Jain M, Gopal L, Padhi TR. Dome-shaped maculopathy: a review[J]. Eye (Lond), 2021, 35(9): 2458-2467. DOI: 10.1038/s41433-021-01518-w.
26. 陈秋莹, 樊莹. 高度近视圆顶状黄斑的形态特征及常见并发症治疗[J]. 中华眼底病杂志, 2016, 32(3): 323-326. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.026.Chen QY, Fan Y. The morphological characteristics and complications treatment of dome-shaped macula in high myopia[J]. Chin J Ocul Fundus Dis, 2016, 32(3): 323-326. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.026.
27. Kumar V, Verma S, Azad SV, et al. Dome-shaped macula-review of literature[J]. Surv Ophthalmol, 2021, 66(4): 560-571. DOI: 10.1016/j.survophthal.2020.11.002.
28. Dai F, Li S, Wang Y, et al. Correlation between posterior staphyloma and dome-shaped macular in high myopia[J]. Retina, 2020, 40(11): 2119-2126. DOI: 10.1097/IAE.0000000000002722.
29. Fang D, Zhang Z, Wei Y, et al. The morphological relationship between dome-shaped macula and myopic retinoschisis: a cross-sectional study of 409 highly myopic eyes[J]. Invest Ophthalmol Vis Sci, 2020, 61(3): 19. DOI: 10.1167/iovs.61.3.19.
30. Ripa M, Motta L, Matello V, et al. Long-term results of macular buckle for MTM stage 3-4 with maculoschisis and macular detachment without and with lamellar macular hole[J]. Eur J Ophthalmol, 2024, 34(6): 1828-1836. DOI: 10.1177/11206721241234958.
31. Parolini B, Palmieri M, Finzi A, et al. The new myopic traction maculopathy staging system[J]. Eur J Ophthalmol, 2021, 31(3): 1299-1312. DOI: 10.1177/1120672120930590.

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Imaging features of pathological myopic perivascular abnormalities and macular retinoschisis and their correlation with clinical features

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