The efficacy of posterior scleral reinforcement for macular retinoschisis in pathological myopia_Chinese Journal of Ocular Fundus Diseases

Authors：

MaoGuangyun , WangYuqin , 王毓琴 , 宋宗明 ,  薛安全

Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China;

Corresponding author：

薛安全, Email: safesnow88@aliyun.com.cn

Keywords：

Myopia, degenerative/complications; Retinal perforations/surgery; Scleroplasty

DOI：

10.3760/cma.j.issn.1005-1015.2015.04.003

Video：

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Objective To evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in pathological myopic patients. Methods A prospective study was conducted, in which 36 pathological myopia patients(36 eyes)with myopic foveoschisis were enrolled and divided into two groups according to the treatments: 24 patients (24 eyes) voluntarily underwent posterior scleral reinforcement (PSR, operation group) and 12 patients (12 eyes) didn't receive operation (control group). There are no statistical differences (P>0.05) in age, gender, length of axis oculi, spherical equivalent between the 2 groups. All patients were examined by best corrected visual acuity (BCVA), macular retinoschisis types, central foveal thickness (CFT), maximum foveal thickness (MxFT). Patients in operation group were scheduled to a follow-up 3rd, 6th, and 9th month after surgery respectively. Patients in control group all were followed up once every three months. A contrast observation was made on the changes of BCVA, CFT, MxFT, findings of the foveoschisis and the complications of the surgery between groups. Results Compared with the preoperation after 9 month follow-up: in the operation group, the BCVA was significantly increased postoperatively (Z=-3.43, P=0.01), the mean CFT was significantly decreased postoperatively (Z=-2.71, P=0.007), while the MxFT which was not significantly decreased postoperatively (Z=-0.67, P=0.503). In the control group, there was no significant change in BCVA (Z=-1.840, P>0.05), the CFT and the MxFT were signi? cant increased respectively (Z=-2.803, -2.04; P<0.05). In the operation group, there were 6 (25.0%) of the 24 eyes get complete resolution of the foveoschisis; 16 (66.7%) of them is not completely attached however the retinoschisis was significantly decreased; only 2 eyes developed to macular hole the other getting worse and the foveal thickness was increased. In the control group no one get complete resolution of the myopic foveoschisis, and 2 eyes developed to retinal detachment in 6 and 8 month respectively. There was no complications such as post-operative intra-ocular pressure increased, subretinal hemorrhage, macular epiretinal membrane, endophthalmitis, vortex vein circumfluence obstacle and anterior ocular ischemia syndrome occurred after surgery. Conclusions Posterior scleral reinforcement surgery was found effective in improving the visual acuity, reducing the CFT. No obvious complications were found during and after the surgery.

Citation： MaoGuangyun, WangYuqin. The efficacy of posterior scleral reinforcement for macular retinoschisis in pathological myopia. Chinese Journal of Ocular Fundus Diseases, 2015, 31(4): 324-328. doi: 10.3760/cma.j.issn.1005-1015.2015.04.003 Copy

1.	Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476.
2.	Phillips CI. Retinal detachment at the posterior pole[J]. Br J Ophthalmol, 1958, 42(12): 749-753.
3.	Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800.
4.	Kanda S, Uemura A, Sakamoto Y, et al. Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes[J]. Am J Ophthalmol, 2003, 136(1): 177-180.
5.	Qi Y, Duan AL, You QS, et al. Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia[J]. Retina, 2015, 35(2): 351-357.
6.	孙敏, 孙吉君, 宋宗明. 玻璃体视网膜手术治疗病理性近视黄斑劈裂的疗效观察及视力预后影响因素分析[J]. 中华眼底病杂志, 2012, 28(2): 117-120.
7.	Baba T, Tanaka S, Maesawa A, et al. Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole[J]. Am J Ophthalmol, 2006, 142(3): 483-487.
8.	Wu PC, Chen YJ, Chen YH, et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond), 2009, 23(2): 356-361.
9.	Zhu Z, Ji X, Zhang J, et al. Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J]. Clin Experiment Ophthalmol, 2009, 37(7): 660-663.
10.	Holladay JT. Proper method for calculating average visual acuity[J]. J Refract Surg, 1997, 13(4): 388-391.
11.	张娅萍, 薛安全, 王毓琴, 等. 非内界膜剥离的玻璃体切除术对病理性近视黄斑劈裂疗效的临床研究[J]. 中华眼科杂志, 2011, 47(6): 497-503.
12.	Taban M, Sharma S, Williams DR, et al. Comparing retinal thickness measurements using automated fast macular thickness map versus six-radial line scans with manual measurements[J]. Ophthalmology, 2009, 116(5): 964-970.
13.	Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(3): 462-467.
14.	Xue A, Bao F, Zheng L, et al. Posterior scleral reinforcement on progressive high myopic young patients[J]. Optom Vis Sci, 2014, 91(4): 412-418.
15.	朱双倩, 王勤美, 郑林燕, 等. 后巩膜加固术治疗病理性近视黄斑劈裂[J]. 中华眼视光学与视觉科学杂志, 2014, 16(3):177-180.
16.	Shimada N, Ohno-Matsui K, Yoshida T, et al. Progression from macular retinoschisis to retinal detachment in highly myopic eyes is associated with outer lamellar hole formation[J]. Br J Ophthalmol, 2008, 92(6): 762-764.

1. Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476.
2. Phillips CI. Retinal detachment at the posterior pole[J]. Br J Ophthalmol, 1958, 42(12): 749-753.
3. Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800.
4. Kanda S, Uemura A, Sakamoto Y, et al. Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes[J]. Am J Ophthalmol, 2003, 136(1): 177-180.
5. Qi Y, Duan AL, You QS, et al. Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia[J]. Retina, 2015, 35(2): 351-357.
6. 孙敏, 孙吉君, 宋宗明. 玻璃体视网膜手术治疗病理性近视黄斑劈裂的疗效观察及视力预后影响因素分析[J]. 中华眼底病杂志, 2012, 28(2): 117-120.
7. Baba T, Tanaka S, Maesawa A, et al. Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole[J]. Am J Ophthalmol, 2006, 142(3): 483-487.
8. Wu PC, Chen YJ, Chen YH, et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond), 2009, 23(2): 356-361.
9. Zhu Z, Ji X, Zhang J, et al. Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J]. Clin Experiment Ophthalmol, 2009, 37(7): 660-663.
10. Holladay JT. Proper method for calculating average visual acuity[J]. J Refract Surg, 1997, 13(4): 388-391.
11. 张娅萍, 薛安全, 王毓琴, 等. 非内界膜剥离的玻璃体切除术对病理性近视黄斑劈裂疗效的临床研究[J]. 中华眼科杂志, 2011, 47(6): 497-503.
12. Taban M, Sharma S, Williams DR, et al. Comparing retinal thickness measurements using automated fast macular thickness map versus six-radial line scans with manual measurements[J]. Ophthalmology, 2009, 116(5): 964-970.
13. Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(3): 462-467.
14. Xue A, Bao F, Zheng L, et al. Posterior scleral reinforcement on progressive high myopic young patients[J]. Optom Vis Sci, 2014, 91(4): 412-418.
15. 朱双倩, 王勤美, 郑林燕, 等. 后巩膜加固术治疗病理性近视黄斑劈裂[J]. 中华眼视光学与视觉科学杂志, 2014, 16(3):177-180.
16. Shimada N, Ohno-Matsui K, Yoshida T, et al. Progression from macular retinoschisis to retinal detachment in highly myopic eyes is associated with outer lamellar hole formation[J]. Br J Ophthalmol, 2008, 92(6): 762-764.

Chinese Journal of Ocular Fundus Diseases

The efficacy of posterior scleral reinforcement for macular retinoschisis in pathological myopia

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