Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic_Chinese Journal of Ocular Fundus Diseases

Authors：

Tao Jiwei , Lin Yanwen ,  Shen Lijun , Chen Yiqi , Mao Jianbo , Chen Huan , Yu Xueting , Fang Jia

Eye Hospital of Wenzhou Medical University, Hangzhou 310020, China;

Corresponding author：

Shen Lijun, Email: 13868302929@139.com

Keywords：

Retinoschisis; Myopia, degenerative/complications; Vitrectomy

DOI：

10.3760/cma.j.issn.1005-1015.2019.05.004

Video：

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Objective To observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic.Methods A prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12% C₃F₈ was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.Results The foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20; P＜0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.Conclusions Pars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.

Citation： Tao Jiwei, Lin Yanwen, Shen Lijun, Chen Yiqi, Mao Jianbo, Chen Huan, Yu Xueting, Fang Jia. Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic. Chinese Journal of Ocular Fundus Diseases, 2019, 35(5): 441-445. doi: 10.3760/cma.j.issn.1005-1015.2019.05.004 Copy

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2.	Baba T, Ohno-Matsui K, Futagami S, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia[J]. Am J Ophthalmol, 2003, 135(3): 338-342. DOI: 10.1016/s0002-9394(02)01937-2.
3.	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. DOI: 10.1016/j.ajo.2006.10.053.
4.	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.
5.	Zheng B, Chen Y, Chen Y, et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis[J]. Retina, 2011, 31(4): 692-701. DOI: 10.1097/IAE.0b013e3181f84fc1.
6.	Figueroa MS, Ruiz-moreno JM, Govetto A, et al. Long-term outcomes of 23-Gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for myopic traction maculopathy[J]. Retina, 2015, 35(9): 1836-1843. DOI: 10.1097/IAE.0000000000000554.
7.	Rodrigues IA, Stangos AN, Mchugh DA, et al. Intravitreal injection of expansile perfluoropropane (C₃F₈) for the treatment of vitreomacular traction[J]. Am J Ophthalmol, 2013, 155(2): 270-276. DOI: 10.1016/j.ajo.2012.08.018.
8.	Mii M, Matsuoka M, Matsuyama K, et al. Favorable anatomic and visual outcomes with 25-gauge vitrectomy for myopic foveoschisis[J]. Clin Ophthalmol, 2014, 8: 1837-1844. DOI: 10.2147/OPTH.S67619.
9.	Hirakata A, Hida T. Vitrectomy for myopic posterior retinoschisis or foveal detachment[J]. Jpn J Ophthalmol, 2006, 50(1): 53-61. DOI: 10.1007/s10384-005-0270-4.
10.	Spaide RF. "Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling[J]. Retina, 2012, 32(9): 1719-1726. DOI: 10.1097/IAE.0b013e3182671191.
11.	Ho TC, Chen MS, Huang JS, et al. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery[J]. Retina, 2012, 32(3): 631-634. DOI: 10.1097/IAE.0B013E31824D0A4B.
12.	Shimada N, Sugamoto Y, Ogawa M, et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy[J]. Am J Ophthalmol, 2012, 154(4): 693-701. DOI: 10.1016/j.ajo.2012.04.013.
13.	Ho TC, Yang CM, Huang JS, et al. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy[J]. Retina, 2014, 34(9): 1833-1840. DOI: 10.1097/IAE.0000000000000149.
14.	Lee CL, Wu WC, Chen KJ, et al. Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery[J]. Acta Ophthalmol, 2017, 95(2): 128-131. DOI: 10.1111/aos.13115.
15.	Jin H, Zhang Q, Zhao P. Fovea sparing internal limiting membrane peeling using multiple parafoveal curvilinear peels for myopic foveoschisis: technique and outcome[J]. BMC Ophthalmol, 2016, 16(1): 180. DOI: 10.1186/s12886-016-0356-4.

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. DOI: 10.1016/s0002-9394(99)00186-5.
2. Baba T, Ohno-Matsui K, Futagami S, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia[J]. Am J Ophthalmol, 2003, 135(3): 338-342. DOI: 10.1016/s0002-9394(02)01937-2.
3. 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. DOI: 10.1016/j.ajo.2006.10.053.
4. 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.
5. Zheng B, Chen Y, Chen Y, et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis[J]. Retina, 2011, 31(4): 692-701. DOI: 10.1097/IAE.0b013e3181f84fc1.
6. Figueroa MS, Ruiz-moreno JM, Govetto A, et al. Long-term outcomes of 23-Gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for myopic traction maculopathy[J]. Retina, 2015, 35(9): 1836-1843. DOI: 10.1097/IAE.0000000000000554.
7. Rodrigues IA, Stangos AN, Mchugh DA, et al. Intravitreal injection of expansile perfluoropropane (C₃F₈) for the treatment of vitreomacular traction[J]. Am J Ophthalmol, 2013, 155(2): 270-276. DOI: 10.1016/j.ajo.2012.08.018.
8. Mii M, Matsuoka M, Matsuyama K, et al. Favorable anatomic and visual outcomes with 25-gauge vitrectomy for myopic foveoschisis[J]. Clin Ophthalmol, 2014, 8: 1837-1844. DOI: 10.2147/OPTH.S67619.
9. Hirakata A, Hida T. Vitrectomy for myopic posterior retinoschisis or foveal detachment[J]. Jpn J Ophthalmol, 2006, 50(1): 53-61. DOI: 10.1007/s10384-005-0270-4.
10. Spaide RF. "Dissociated optic nerve fiber layer appearance" after internal limiting membrane removal is inner retinal dimpling[J]. Retina, 2012, 32(9): 1719-1726. DOI: 10.1097/IAE.0b013e3182671191.
11. Ho TC, Chen MS, Huang JS, et al. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery[J]. Retina, 2012, 32(3): 631-634. DOI: 10.1097/IAE.0B013E31824D0A4B.
12. Shimada N, Sugamoto Y, Ogawa M, et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy[J]. Am J Ophthalmol, 2012, 154(4): 693-701. DOI: 10.1016/j.ajo.2012.04.013.
13. Ho TC, Yang CM, Huang JS, et al. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy[J]. Retina, 2014, 34(9): 1833-1840. DOI: 10.1097/IAE.0000000000000149.
14. Lee CL, Wu WC, Chen KJ, et al. Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery[J]. Acta Ophthalmol, 2017, 95(2): 128-131. DOI: 10.1111/aos.13115.
15. Jin H, Zhang Q, Zhao P. Fovea sparing internal limiting membrane peeling using multiple parafoveal curvilinear peels for myopic foveoschisis: technique and outcome[J]. BMC Ophthalmol, 2016, 16(1): 180. DOI: 10.1186/s12886-016-0356-4.

Chinese Journal of Ocular Fundus Diseases

Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic

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