Comparison of the efficacy of vitrectomy combined with complete internal limiting membrane peeling and fovea-sparing internal limiting membrane peeling for high myopia macular foveoschisis_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhu Li ,  Chen Xiao , Yan Ying , Ding Qin , Hu Cheng , Huang Zhijian

Department of Ophthalmology, Central Theater Command General Hospital, Wuhan 430070, China;

Corresponding author：

Chen Xiao, Email: cxfn817@163.com

Keywords：

Myopia, degenerative/surgery; Retinoschisis/surgery; Retinal perforations/surgery; Vitrectomy

DOI：

10.3760/cma.j.cn511434-20200102-00001

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Objective To observe and compare the outcomes of vitrectomy (PPV) combined with complete internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling for the high myopic foveoschisis (MF).Methods A retrospective case study was performed. From June 2016 to June 2018, 31 eyes of 31 patients with high myopic MF diagnosed in Department of Ophthalmology of Central Theater Command General Hospital were included in the study. There were 9 males and 22 females, who were monocular. The mean age was 57.55±9.45 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. Snellen visual acuity chart was used for BCVA examination, and which was converted into logMAR visual acuity. According to the surgical method, patients were divided into PPV combined with ILM complete removal group (group A) and PPV combined with retained fovea ILM group (group B), which were 16 patients (16 eyes) and 15 patients (15 eyes ), respectively. The mean logMAR BCVA was 1.03±0.33 in group A and 1.11±0.35 in group B. The mean CFT was 596.51±196.69 μm in group A and 578.33±200.18 μm. There were no statistically significant differences in age (t=0.649, P=0.527), AL (t=－0.639, P=0.533), logMAR BCVA (t=－0.368, P=0.718), CFT (t=0.228, P=0.823) and MF type (P=0.576) between the two groups. The mean follow-up time after operation was 18.65±5.15 months. At 7 d, 1, 3, 6 and 12 months after surgery, and at the last follow-up, the same equipment and methods for relevant examinations. The changes of BCVA, CFT, macular hole and other complications were compared between the two groups. Comparison of BCVA and CFT between the two groups before and after operation was performed by paired t test. The count data were compared by using Fisher exact probability method.Results At the last follow-up, MF was completely restored in 27 eyes (87.1%) of 31 eyes, partially restored in 4 eyes (12.9%). The mean logMAR BCVA of group A and Group B was 0.67±0.24 and 0.64±0.21, respectively. The average CFT was 126.25±36.61 μm and 134.27±25.29 μm, respectively. Compared with pre-operation, BCVA was obviously improved in both groups (t=6.630, 9.260; P=0.000, 0.000), CFT was significantly decreased in both groups (t=10.206, 8.799; P=0.000, 0.000). There were no statistically significant differences in logMAR BCVA and CFT between the two groups (t=0.156, －0.924; P=0.878, 0.371). In group A, full-thickness macular hole occurred in 1 eye (6.3%), while no macular hole occurred in group B. There was no significant difference in macular hole incidence between two groups (χ²=0.969, P=0.516). No intraocular hemorrhage, endophthalmitis and other complications occurred during the follow-up period.Conclusions PPV combined with ILM peeling or fovea-sparing ILM peeling is effective in the treatment of high myopic MF. Both may contribute to improved MF closure rate and BCVA.

Citation： Zhu Li, Chen Xiao, Yan Ying, Ding Qin, Hu Cheng, Huang Zhijian. Comparison of the efficacy of vitrectomy combined with complete internal limiting membrane peeling and fovea-sparing internal limiting membrane peeling for high myopia macular foveoschisis. Chinese Journal of Ocular Fundus Diseases, 2020, 36(7): 509-513. doi: 10.3760/cma.j.cn511434-20200102-00001 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. 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.	Bando H, Ikuno Y, Choi JS, et al. Ultrastructure of internal limiting membrane in myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(1): 197-199. DOI: 10.1016/j.ajo.2004.07.027.
4.	Ripandelli G, Rossi T, Scarinci F, et al. Macular vitreoretinal interface abnormalities in highly myopic eyes with posterior staphyloma: 5-year follow-up[J]. Retina, 2012, 32(8): 1531-1538. DOI: 10.1097/IAE.0b013e318255062c.
5.	Kim KS, Lee SB, Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis[J]. Am J Ophthalmol, 2012, 153(2): 320-326. DOI: 10.1016/j.ajo.2011.07.007.
6.	Ikuno Y, Sayanagi K, Soga K, et a1. 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.
7.	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 tractionmaculopathy: a prospective study[J]. Retina, 2015, 35(9): 1836-1843. DOI: 10.1097/IAE.0000000000000554.
8.	Hattori K, Kataoka K, Takeuchi J, et al. Predictive factors of surgical outcomes in vitrectomy for myopic traction maculopathy[J]. Retina, 2018, 38 Suppl 1: S23-30. DOI: 10.1097/IAE.0000000000001927.
9.	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.
10.	Shimada N, Sugamoto Y, Ogawa M,et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy[J]. Am J Opthalmol, 2012, 154(4): 693-701. DOI: 10.1016/j.ajo.2012.04.013.
11.	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.
12.	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.
13.	Iwasaki M, Miyamoto H, Okushiba U, et al. Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy[J]. Jpn J Ophthalmol, 2020, 64(1): 13-21. DOI: 10.1007/s10384-019-00696-1.
14.	Elwan MM, Abd Elghafar AE, Hagras SM, et al. Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis[J]. Eur J Ophthalmol, 2019, 29(1): 69-74. DOI: 10.1177/1120672117750059.
15.	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.
16.	Lehmann M, Devin F, Rothschild PR, et, al. Preoperative factors influencing visual recovery after vitrectomy for myopic foveoschisis[J]. Retina, 2019, 39(3): 594-600. DOI: 10.1097/IAE.0000000000001992.
17.	Yun LN, Xing YQ. Long-term outcome of highly myopic foveoschisis treated by vitrectomy with or without gas tamponade[J]. Int J Ophthalmol, 2017, 10(9): 1392-1395. DOI: 10.18240/ijo.2017.09.10.
18.	Meng B, Zhao L, Yin Y, et al. Internal limiting membrane peeling and gas tamponade for myopic foveoschisis: a systematic review and meta-analysis[J]. BMC Ophthalmol, 2017, 17(1): 166. DOI: 10.1186/s12886-017-0562-8.
19.	Russo A, Morescalchi F, Gambicorti E, et al. Epiretinal membrane removal with foveal-sparing internal limiting membrane peeling: a pilot study[J]. Retina, 2019, 39(11): 2116-2124. DOI: 10.1097/IAE.0000000000002274.
20.	陶继伟, 林艳雯, 沈丽君, 等. 玻璃体切割联合保留中心凹内界膜剥除手术治疗高度近视黄斑劈裂的长期疗效观察[J]. 中华眼底病杂志, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.Tao JW, Lin YW, Shen LJ, et al. Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic[J]. Chin J Ocul Fundus Dis, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.

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. Bando H, Ikuno Y, Choi JS, et al. Ultrastructure of internal limiting membrane in myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(1): 197-199. DOI: 10.1016/j.ajo.2004.07.027.
4. Ripandelli G, Rossi T, Scarinci F, et al. Macular vitreoretinal interface abnormalities in highly myopic eyes with posterior staphyloma: 5-year follow-up[J]. Retina, 2012, 32(8): 1531-1538. DOI: 10.1097/IAE.0b013e318255062c.
5. Kim KS, Lee SB, Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis[J]. Am J Ophthalmol, 2012, 153(2): 320-326. DOI: 10.1016/j.ajo.2011.07.007.
6. Ikuno Y, Sayanagi K, Soga K, et a1. 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.
7. 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 tractionmaculopathy: a prospective study[J]. Retina, 2015, 35(9): 1836-1843. DOI: 10.1097/IAE.0000000000000554.
8. Hattori K, Kataoka K, Takeuchi J, et al. Predictive factors of surgical outcomes in vitrectomy for myopic traction maculopathy[J]. Retina, 2018, 38 Suppl 1: S23-30. DOI: 10.1097/IAE.0000000000001927.
9. 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.
10. Shimada N, Sugamoto Y, Ogawa M,et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy[J]. Am J Opthalmol, 2012, 154(4): 693-701. DOI: 10.1016/j.ajo.2012.04.013.
11. 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.
12. 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.
13. Iwasaki M, Miyamoto H, Okushiba U, et al. Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy[J]. Jpn J Ophthalmol, 2020, 64(1): 13-21. DOI: 10.1007/s10384-019-00696-1.
14. Elwan MM, Abd Elghafar AE, Hagras SM, et al. Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis[J]. Eur J Ophthalmol, 2019, 29(1): 69-74. DOI: 10.1177/1120672117750059.
15. 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.
16. Lehmann M, Devin F, Rothschild PR, et, al. Preoperative factors influencing visual recovery after vitrectomy for myopic foveoschisis[J]. Retina, 2019, 39(3): 594-600. DOI: 10.1097/IAE.0000000000001992.
17. Yun LN, Xing YQ. Long-term outcome of highly myopic foveoschisis treated by vitrectomy with or without gas tamponade[J]. Int J Ophthalmol, 2017, 10(9): 1392-1395. DOI: 10.18240/ijo.2017.09.10.
18. Meng B, Zhao L, Yin Y, et al. Internal limiting membrane peeling and gas tamponade for myopic foveoschisis: a systematic review and meta-analysis[J]. BMC Ophthalmol, 2017, 17(1): 166. DOI: 10.1186/s12886-017-0562-8.
19. Russo A, Morescalchi F, Gambicorti E, et al. Epiretinal membrane removal with foveal-sparing internal limiting membrane peeling: a pilot study[J]. Retina, 2019, 39(11): 2116-2124. DOI: 10.1097/IAE.0000000000002274.
20. 陶继伟, 林艳雯, 沈丽君, 等. 玻璃体切割联合保留中心凹内界膜剥除手术治疗高度近视黄斑劈裂的长期疗效观察[J]. 中华眼底病杂志, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.Tao JW, Lin YW, Shen LJ, et al. Long-term efficacy of pars plana vitrectomy with fovea-sparing internal limiting peeling for macular foveoschisis in pathologic myopic[J]. Chin J Ocul Fundus Dis, 2019, 35(5): 441-445. DOI: 10.3760/cma.j.issn.1005-1015.2019.05.004.

Chinese Journal of Ocular Fundus Diseases

Comparison of the efficacy of vitrectomy combined with complete internal limiting membrane peeling and fovea-sparing internal limiting membrane peeling for high myopia macular foveoschisis

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