Pars Plana Vitrectomy with Internal Limiting Membrane Peeling in Patients with Myopic Foveoschisis

Objective: To report the clinical and surgical outcomes of patients with myopic foveoschisis (MF). Methods: Thirteen eyes in ten symptomatic MF patients who underwent pars plana vitrectomy (PPV) and gas tamponade with internal limiting membrane (ILM) peeling were retrospectively identified. Best corrected visual acuity (BCVA) and central foveal thickness (CFT) were assessed preoperatively and six months postoperatively. Complications during and after surgery were also recorded. Results: The median BCVA significantly improved from 20/160 to 20/100 (p = 0.03). In subgroup analysis, eight eyes (61%) demonstrated significant BCVA improvements from 20/80 to 20/50 (p < 0.001), whereas five eyes had similar BCVA with preoperative level after six months of surgery (p=0.32). The mean CFT decreased from 526 microns at baseline to 214 microns at six months of surgery (p < 0.001). Optical coherence tomography scans revealed a complete MF resolution in ten eyes (76%) and a partial MF resolution in three eyes. Peripheral retinal tear was developed in one patient during surgery and one patient had cataract after surgery, those were treated accordingly. Conclusion: PPV with ILM peeling followed by gas tamponade is a safe and effective procedure for the treatment of eyes with myopic foveoschisis. Larger studies with longer follow-ups will further establish the efficacy and safety of this procedure. J Clin Exp Invest 2016; 7 (2): 139-143

Keywords:

Myopic foveoschisis, retinoschisis, macular hole internal limiting membrane,

PDF

___

1. Benhamou N, Massin P, Haouchine B, et al. Macular reti - noschisis in highly myopic eyes. Am J Ophthalmol. 2002;133:794-800. 2. Takano M, Kishi S. Foveal retinoschisis and retinal detach - ment in severely myopic eyes with posterior staphyloma. Am J Ophthalmol. 1999;128:472-6. 3. Panozzo G, Mercanti A. Optical coherence tomography find - ings in myopic traction maculopathy. Arch Ophthalmol. 2004;122:1455-60. 4. Shimada N, Ohno-Matsui K, Baba T, et al. Natural course of macular retinoschisis in highly myopic eyes without macu - lar hole or retinal detachment. Am J Ophthalmol. 2006;142: 497-500. 5. Ikuno Y, Sayanagi K, Soga K, et al. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis. Jpn J Ophthalmol. 2008;52:269-76. 6. Kobayashi H, Kishi S. Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. Ophthal - mology 2003;110:1702-7. 7. Mateo C, Burés-Jelstrup A, Navarro R, Corcóstegui B. Mac - ular buckling for eyes with myopic foveoschisis secondary to posterior staphyloma. Retina. 2012;32:1121-8. 8. Ji X, Wang J, Zhang J, et al. The effect of posterior scleral reinforcement for high myopia macular splitting. J Int Med Res. 2011;39:662-6. 9. Tang J, Rivers MB, Moshfeghi AA, et al. Pathology of macu - lar foveoschisis associated with degenerative myopia. J Ophthalmol. 2010;55:10-6. 10. Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis. Am J Ophthalmol. 2005;139:462-7. 11. Baba T, Ohno-Matsui K, Futagami S, et al. Prevalence and characteristics of foveal retinal detachment without macu - lar hole in high myopia. Am J Ophthalmol. 2003;135:338- 42. 12. Ikuno Y, Sayanagi K, Ohji M, et al. Vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Am J Ophthalmol. 2004;137:719-24. 13. Chang JS, Flynn HW Jr, Engelbert M, et al. Pars plana vit - rectomy in patients with myopic macular retinoschisis. Br J Ophthalmol. 2014;98:534-7. 14. Fang X, Weng Y, Xu S, et al. Optical coherence tomograph - ic characteristics and surgical outcome of eyes with myopic foveoschisis. Eye (Lond). 2009;23:1336-42. 15. Kuhn F. Internal limiting membrane removal for macu - lar detachment in highly myopic eyes. Am J Ophthalmol. 2003;135:547-9. 16. Kanda S, Uemura A, Sakamoto Y, Kita H. Vitrectomy with internal limiting membrane peeling for macular retinoschi - sis and retinal detachment without macular hole in highly myopic eyes. Am J Ophthalmol. 2003;136:177-80. 17. Sayanagi K, Ikuno Y, Tano Y. Reoperation for persistent myopic foveoschisis after primary vitrectomy. Am J Oph - thalmol. 2006;141:414-7. 18. Shimada N, Sugamoto Y, Ogawa M, et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol. 2012;154:693-701. 19. Ho TC, Chen MS, Huang JS, et al. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery. Retina. 2012;32:631-4. 20. Kwok AK, Lai TY, Yip WW. Vitrectomy and gas tampon - ade without internal limiting membrane peeling for myopic foveoschisis. Br J Ophthalmol. 2005;89:1180-3.