The efficacy of vitrectomy for myopic traction maculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

XiaHuijuan , WangWeijun , WuYing , ChenWei , QiuQinghua , ChenFeng'e ,  FanYing

Department of Ophthalmology, The First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200080, China(Xia Huijuan, graduate student, now working at the Department of Ophthalmology, The First Hospital of Jiaxing, Jiaxing 314000, China);

Corresponding author：

FanYing, Email: mdfanying@sjtu.edu.cn

Keywords：

Myopia,degenerative/complications; Myopia,degenerative/surgery; Vitreoretinal surgery

DOI：

10.3760/cma.j.issn.1005-1015.2016.05.006

Video：

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Objective To observe the anatomical and functional changes in patients with different degrees of myopic traction maculopathy (MTM) after vitrectomy. Methods It was a retrospective case series study. Forty-seven consecutive patients (47 eyes) diagnosed with MTM were studied between January 2010 and May 2014. There were 38 females (38 eyes) and 9 male (9 eyes),mean age was (65.13±6.98) years, mean axial length was (29.23±1.77) mm. The eyes was divided into 3 groups according to the macular morphologies on optical coherence tomography (OCT), including macular retinoschisis only group (MRS group, 18 eyes), foveal retinal detachment group (FD group, 13 eyes) and full-thickness macular hole group (MH group, 16 eyes). All the eyes underwent minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA), intraocular pressure, axial length, A or B- ultrasonography, fundus photography, OCT and microperimetry examinations. The average logMAR BCVA of 47 eyes was 1.43±0.52. The center retinal thickness (CRT) of eyes in MRS and FD group was (528.45±167.61) μm. All the patients underwent pars plana vitrectomy combined with internal limiting membrane peeling. The mean follow-up period was 23.4 months. The changes of logMAR BCVA, microperimetry and macular microstructural were observed. Results At the final follow-up, the logMAR BCVA of 47 eyes was 0.86±0.42, which improved compared with the preoperative vision (t=7.36,P<0.001). The mean CRT of eyes in MRS and FD group was (250.90±91.81) μm, which improved compared with the preoperative CRT (t=8.17,P<0.001). In MRS group, the retina was attached in 18 eyes. In FD group, the retina was attached in 11 eyes, MH was observed in 2 eyes. In MH group, recurrent retinal detachment was observed in 1 eye. The differences of logMAR BCVA and retinal sensitivity among MRS, FD and MH groups were significant (χ²=6.38, 11.08; P=0.030, 0.004). Conclusion The macular structural and visual function in MTM eyes with macular retinoschisis only after vitrectomy are better than those in MTM eyes with MH and foveal retinal detachment.

Citation： XiaHuijuan, WangWeijun, WuYing, ChenWei, QiuQinghua, ChenFeng'e, FanYing. The efficacy of vitrectomy for myopic traction maculopathy. Chinese Journal of Ocular Fundus Diseases, 2016, 32(5): 481-485. doi: 10.3760/cma.j.issn.1005-1015.2016.05.006 Copy

1.	Gaucher D, Haouchine B, Tadayoni R,et al. Long-term follow-up of high myopic foveoschisis:natural course and surgical outcome[J]. Am J Ophthalmol, 2007, 143(3):455-462.
2.	Taniuchi S, Hirakata A, Itoh Y, et al. Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy[J]. Retina, 2013,33(10):2018-2025.DOI:10.1097/IAE.0b013e3182a4892b.
3.	Ikuno Y, Sayanagi K, Ohji M,et al. Vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Am J Ophthalmol, 2004, 137(4):719-724.
4.	Uchida A, Shinoda H, Koto T, et al. Vitrectomy for myopic foveoschisis with internal limiting membrane peeling and no gas tamponade[J]. Retina, 2014, 34(3):455-460. DOI:10.1097/IAE.0b013e3182a0e477.
5.	Lim SJ, Kwon YH, Kim SH,et al. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(11):1573-1577.DOI:10.1007/s00417-012-1983-y.
6.	Hwang JU, Joe SG, Lee JY,et al. Microincision vitrectomy surgery for myopic foveoschisis[J]. Br J Ophthalmol, 2013, 97(7):879-884.DOI:10.1136/bjophthalmol-2012-302906.
7.	Theodossiadis PG, Grigoropoulos VG, Theodossiadis GP. The significance of the external limiting membrane in the recovery of photoreceptor layer after successful macular hole closure:a study by spectral domain optical coherence tomography[J]. Ophthalmologica, 2011, 225(3):176-184.DOI:10.1159/000323322.
8.	Ikuno Y, Sayanagi K, Soga K,et al. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis[J]. Jpn J Ophthalmol, 2008, 52(4):269-276. DOI:10.1007/s10384-008-0544-8.
9.	Rey A, Jürgens I, Maseras X,et al. Natural course and surgical management of high myopic foveoschisis[J]. Ophthalmologica, 2014, 231(1):45-50.DOI:10.1159/000355324.
10.	魏雁涛, 凌运兰,黄雄高,等. 微创玻璃体切割联合内界膜剥除治疗高度近视黄斑劈裂手术后黄斑结构与功能研究[J].中华眼底病杂志, 2013, 29(2):193-195. DOI:10.3760/cma.j.issn.1005-1015.2013.02.017. Wei YT,Ling YL,Huang XG,et al.Macular structure and function of macular retinoschisis in high myopic eyes after micro-invasive vitrectomy combined with internal limiting membrane peeling[J].Chin J Ocul Fundus Dis,2013, 29(2):193-195. DOI:10.3760/cma.j.issn.1005-1015.2013.02.017.
11.	马进, 朱铁培,张倩茹,等.高度近视黄斑劈裂视网膜内界膜剥离手术联合全氟丙烷眼内填充疗效评价[J].中华眼底病杂志,2012,28(2):341-343. DOI:10.3760/cma.j.issn.1005-1015.2009.05.05. Ma J,Zhu TP,Zhang QR,et al.Internal limiting membrane peeling and perfluoropropane tamponade for macular retinoschisis with high myopia[J].Chin J Ocul Fundus Dis,2012, 28(2):341-343. DOI:10.3760/cma.j.issn.1005-1015.2009.05.05.
12.	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.DOI:10.3760/cma.j.issn.1005-1015.2012.02.003. Sun M,Sun JJ,Song ZM.The visual prognostic factors in vitreoretinal surgery for myopic foveoschisis[J].Chin J Ocul Fundus Dis,2012, 28(2):117-120.DOI:10.3760/cma.j.issn.1005-1015.2012.02.003.
13.	Shin JY, Yu HG. Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy[J]. Retina, 2012, 32(3):486-492.DOI:10.1097/IAE.0b013e31822058d1.
14.	Spaide RF, Fisher Y. Removal of adherent cortical vitreous plaques without removing the internal limiting membrane in the repair of macular detachments in highly myopic eyes[J]. Retina, 2005, 25(3):290-295.
15.	Kwok AK, Lai TY, Yip WW.Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis[J]. Br J Ophthalmol, 2005, 89(9):1180-1183.
16.	Kobayashi H, Kishi S. Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis[J]. Ophthalmology, 2003, 10(9):1702-1707.
17.	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.DOI:10.1136/bjo.2007.131359.
18.	Smiddy WE, Kim SS, Lujan BJ. Myopic traction maculopathy:spectral domain optical coherence tomographic imaging and a hypothesized mechanism[J]. Ophthalmic Surg Lasers Imaging,2009,40(2):169-173.
19.	Sayanagi K, Ikuno Y, Soga K,et al. Photoreceptor inner and outer segment defects in myopic foveoschisis[J]. Am J Ophthalmol,2008,145(5):902-908.DOI:10.1016/j.ajo.2008.01.011.
20.	Fujimoto S, Ikuno Y, Nishida K. Postoperative optical coherence tomographic appearance and relation to visual acuity after vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol, 2013, 156(5):968-973.DOI:10.1016/j.ajo.2013.06.011.
21.	王诗园, 彭清, 赵培泉. 高度近视视网膜劈裂患者手术前后谱域光相干断层扫描影像学特征[J]. 中华眼底病杂志, 2011, 27(2):132-135. DOI:10.3760/cma.j.issn.1005-1015.2011.02.006. Wang SY,Peng Q,Zhao PQ.Image features of spectral-domain optical coherence tomography of high myopia with retinoschisis[J].Chin J Ocul Fundus Dis, 2011, 27(2):132-135.DOI:10.3760/cma.j.issn.1005-1015.2011.02.006.
22.	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.
23.	Cho H, Choi A, Kang SW. Effect of internal limiting membrane removal in treatment of retinal detachment caused by myopic macular hole[J]. Korean J Ophthalmol, 2004, 18(2):141-147.
24.	Patel SC, Loo RH, Thompson JT,et al. Macular hole surgery in high myopia[J]. Ophthalmology, 2001,108(2):377-380.
25.	García-Arumí J, Martinez V, Puig J,et al. The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment[J]. Retina, 2001,21(4):332-338.
26.	Kobayashi H, Kobayashi K, Okinami S. Macular hole and myopic refraction[J]. Br J Ophthalmol, 2002, 86(11):1269-1273.
27.	Nishimura A, Kimura M, Saito Y,et al. Efficacy of primary silicone oil tamponade for the treatment of retinal detachment caused by macular hole in high myopia[J]. Am J Ophthalmol,2011,151(1):148-155. DOI:10.1016/j.ajo.2010.07.023.
28.	Ghoraba HH, Mansour HO, Elgouhary SM. Effect of 360° episcleral band as adjunctive to pars plana vitrectomy and silicone oil tamponade in the management of myopic macular hole retinal detachment[J]. Retina, 2014, 34(4):670-678. DOI:10.1097/IAE.0b013e3182a487ea.
29.	Suda K, Hangai M, Yoshimura N. Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 151(1):118-127.DOI:10.1016/j.ajo.2010.07.007.
30.	Wu TT, Kung YH. Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia:a case-control study using optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(3):327-331. DOI:10.1007/s00417-011-1821-7.
31.	Conart JB, Selton J, Hubert I,et al. Outcomes of macular hole surgery with short-duration positioning in highly myopic eyes:a case-control study[J]. Ophthalmology, 2014,121(6):1263-1268.DOI:10.1016/j.ophtha.2013.12.005.
32.	Ortisi E, Avitabile T, Bonfiglio V. Surgical management of retinal detachment because of macular hole in highly myopic eyes[J]. Retina, 2012, 32(9):1704-1718.DOI:10.1097/IAE.0b013e31826b671c.
33.	Ikuno Y, Tano Y. Vitrectomy for macular holes associated with myopic foveoschisis[J].Am J Ophthalmol,2006, 141(4):774-776.
34.	Sun CB, Liu Z, Xue AQ,et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye (Lond), 2010, 24(12):1787-1791.DOI:10.1038/eye.2010.123.
35.	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.DOI:10.1111/j.1442-9071.2009.02111.x.
36.	Alkabes M, Pichi F, Nucci P, et al. Anatomical and visual outcomes in high myopic macular hole (HM-MH) without retinal detachment:a review[J]. Graefe's Arch Clin Exp Ophthalmol,2014,252(2):191-199.DOI:10.1007/s00417-013-2555-5.
37.	Alkabes M, Padilla L, Salinas C,et al. Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(11):2521-2527.DOI:10.1007/s00417-013-2347-y.

1. Gaucher D, Haouchine B, Tadayoni R,et al. Long-term follow-up of high myopic foveoschisis:natural course and surgical outcome[J]. Am J Ophthalmol, 2007, 143(3):455-462.
2. Taniuchi S, Hirakata A, Itoh Y, et al. Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy[J]. Retina, 2013,33(10):2018-2025.DOI:10.1097/IAE.0b013e3182a4892b.
3. Ikuno Y, Sayanagi K, Ohji M,et al. Vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Am J Ophthalmol, 2004, 137(4):719-724.
4. Uchida A, Shinoda H, Koto T, et al. Vitrectomy for myopic foveoschisis with internal limiting membrane peeling and no gas tamponade[J]. Retina, 2014, 34(3):455-460. DOI:10.1097/IAE.0b013e3182a0e477.
5. Lim SJ, Kwon YH, Kim SH,et al. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(11):1573-1577.DOI:10.1007/s00417-012-1983-y.
6. Hwang JU, Joe SG, Lee JY,et al. Microincision vitrectomy surgery for myopic foveoschisis[J]. Br J Ophthalmol, 2013, 97(7):879-884.DOI:10.1136/bjophthalmol-2012-302906.
7. Theodossiadis PG, Grigoropoulos VG, Theodossiadis GP. The significance of the external limiting membrane in the recovery of photoreceptor layer after successful macular hole closure:a study by spectral domain optical coherence tomography[J]. Ophthalmologica, 2011, 225(3):176-184.DOI:10.1159/000323322.
8. Ikuno Y, Sayanagi K, Soga K,et al. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis[J]. Jpn J Ophthalmol, 2008, 52(4):269-276. DOI:10.1007/s10384-008-0544-8.
9. Rey A, Jürgens I, Maseras X,et al. Natural course and surgical management of high myopic foveoschisis[J]. Ophthalmologica, 2014, 231(1):45-50.DOI:10.1159/000355324.
10. 魏雁涛, 凌运兰,黄雄高,等. 微创玻璃体切割联合内界膜剥除治疗高度近视黄斑劈裂手术后黄斑结构与功能研究[J].中华眼底病杂志, 2013, 29(2):193-195. DOI:10.3760/cma.j.issn.1005-1015.2013.02.017. Wei YT,Ling YL,Huang XG,et al.Macular structure and function of macular retinoschisis in high myopic eyes after micro-invasive vitrectomy combined with internal limiting membrane peeling[J].Chin J Ocul Fundus Dis,2013, 29(2):193-195. DOI:10.3760/cma.j.issn.1005-1015.2013.02.017.
11. 马进, 朱铁培,张倩茹,等.高度近视黄斑劈裂视网膜内界膜剥离手术联合全氟丙烷眼内填充疗效评价[J].中华眼底病杂志,2012,28(2):341-343. DOI:10.3760/cma.j.issn.1005-1015.2009.05.05. Ma J,Zhu TP,Zhang QR,et al.Internal limiting membrane peeling and perfluoropropane tamponade for macular retinoschisis with high myopia[J].Chin J Ocul Fundus Dis,2012, 28(2):341-343. DOI:10.3760/cma.j.issn.1005-1015.2009.05.05.
12. 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.DOI:10.3760/cma.j.issn.1005-1015.2012.02.003. Sun M,Sun JJ,Song ZM.The visual prognostic factors in vitreoretinal surgery for myopic foveoschisis[J].Chin J Ocul Fundus Dis,2012, 28(2):117-120.DOI:10.3760/cma.j.issn.1005-1015.2012.02.003.
13. Shin JY, Yu HG. Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy[J]. Retina, 2012, 32(3):486-492.DOI:10.1097/IAE.0b013e31822058d1.
14. Spaide RF, Fisher Y. Removal of adherent cortical vitreous plaques without removing the internal limiting membrane in the repair of macular detachments in highly myopic eyes[J]. Retina, 2005, 25(3):290-295.
15. Kwok AK, Lai TY, Yip WW.Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis[J]. Br J Ophthalmol, 2005, 89(9):1180-1183.
16. Kobayashi H, Kishi S. Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis[J]. Ophthalmology, 2003, 10(9):1702-1707.
17. 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.DOI:10.1136/bjo.2007.131359.
18. Smiddy WE, Kim SS, Lujan BJ. Myopic traction maculopathy:spectral domain optical coherence tomographic imaging and a hypothesized mechanism[J]. Ophthalmic Surg Lasers Imaging,2009,40(2):169-173.
19. Sayanagi K, Ikuno Y, Soga K,et al. Photoreceptor inner and outer segment defects in myopic foveoschisis[J]. Am J Ophthalmol,2008,145(5):902-908.DOI:10.1016/j.ajo.2008.01.011.
20. Fujimoto S, Ikuno Y, Nishida K. Postoperative optical coherence tomographic appearance and relation to visual acuity after vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol, 2013, 156(5):968-973.DOI:10.1016/j.ajo.2013.06.011.
21. 王诗园, 彭清, 赵培泉. 高度近视视网膜劈裂患者手术前后谱域光相干断层扫描影像学特征[J]. 中华眼底病杂志, 2011, 27(2):132-135. DOI:10.3760/cma.j.issn.1005-1015.2011.02.006. Wang SY,Peng Q,Zhao PQ.Image features of spectral-domain optical coherence tomography of high myopia with retinoschisis[J].Chin J Ocul Fundus Dis, 2011, 27(2):132-135.DOI:10.3760/cma.j.issn.1005-1015.2011.02.006.
22. 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.
23. Cho H, Choi A, Kang SW. Effect of internal limiting membrane removal in treatment of retinal detachment caused by myopic macular hole[J]. Korean J Ophthalmol, 2004, 18(2):141-147.
24. Patel SC, Loo RH, Thompson JT,et al. Macular hole surgery in high myopia[J]. Ophthalmology, 2001,108(2):377-380.
25. García-Arumí J, Martinez V, Puig J,et al. The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment[J]. Retina, 2001,21(4):332-338.
26. Kobayashi H, Kobayashi K, Okinami S. Macular hole and myopic refraction[J]. Br J Ophthalmol, 2002, 86(11):1269-1273.
27. Nishimura A, Kimura M, Saito Y,et al. Efficacy of primary silicone oil tamponade for the treatment of retinal detachment caused by macular hole in high myopia[J]. Am J Ophthalmol,2011,151(1):148-155. DOI:10.1016/j.ajo.2010.07.023.
28. Ghoraba HH, Mansour HO, Elgouhary SM. Effect of 360° episcleral band as adjunctive to pars plana vitrectomy and silicone oil tamponade in the management of myopic macular hole retinal detachment[J]. Retina, 2014, 34(4):670-678. DOI:10.1097/IAE.0b013e3182a487ea.
29. Suda K, Hangai M, Yoshimura N. Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 151(1):118-127.DOI:10.1016/j.ajo.2010.07.007.
30. Wu TT, Kung YH. Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia:a case-control study using optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(3):327-331. DOI:10.1007/s00417-011-1821-7.
31. Conart JB, Selton J, Hubert I,et al. Outcomes of macular hole surgery with short-duration positioning in highly myopic eyes:a case-control study[J]. Ophthalmology, 2014,121(6):1263-1268.DOI:10.1016/j.ophtha.2013.12.005.
32. Ortisi E, Avitabile T, Bonfiglio V. Surgical management of retinal detachment because of macular hole in highly myopic eyes[J]. Retina, 2012, 32(9):1704-1718.DOI:10.1097/IAE.0b013e31826b671c.
33. Ikuno Y, Tano Y. Vitrectomy for macular holes associated with myopic foveoschisis[J].Am J Ophthalmol,2006, 141(4):774-776.
34. Sun CB, Liu Z, Xue AQ,et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye (Lond), 2010, 24(12):1787-1791.DOI:10.1038/eye.2010.123.
35. 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.DOI:10.1111/j.1442-9071.2009.02111.x.
36. Alkabes M, Pichi F, Nucci P, et al. Anatomical and visual outcomes in high myopic macular hole (HM-MH) without retinal detachment:a review[J]. Graefe's Arch Clin Exp Ophthalmol,2014,252(2):191-199.DOI:10.1007/s00417-013-2555-5.
37. Alkabes M, Padilla L, Salinas C,et al. Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(11):2521-2527.DOI:10.1007/s00417-013-2347-y.

Chinese Journal of Ocular Fundus Diseases

The efficacy of vitrectomy for myopic traction maculopathy

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