Macular functional changes after vitrectomy with internal limiting membrane peeling and air filling for myopic foveoschisis by microperimetry_Chinese Journal of Ocular Fundus Diseases

Authors：

Yin Mingyang ^1,2 , Liu Yuyan ^1,2 ,  Han Quanhong ^1,2

1. Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 30020, China;
2. Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, Tianjin 30020, China;

Corresponding author：

Han Quanhong, Email: quanhong16@163.com

Keywords：

Myopia, degenerative; Vitrectomy; Air; Contrast sensitivity; Visual field tests

DOI：

10.3760/cma.j.cn511434-20211111-00639

Video：

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Objective To observe the changes of macular visual function after myopic foveoschisis (MF) and pars plana vitrectomy (PPV) combined with internal limiting membrane peeling and air filling. Methods A single-center, retrospective study. From October 2018 to October 2019, 29 MF inpatients (32 eyes) in Tianjin Eye Hospital were included in this study. There were 3 males (4 eyes) and 26 females (28 eyes). The age was 63.00±3.45 years old. Equivalent spherical lens degree was －14.16±2.54 D, and axial length was 29.14±1.04 mm. Among them, 3 patients (3 eyes) had lamellar macular holes. All eyes underwent standard pars plana three-channel 25G PPV combined with internal limiting membrane peeling and air filling. Before surgery and at 1, 3, and 6 months after surgery, macular microperimetry was performed with a macular integrity assessment instrument, and the mean retinal sensitivitie (MS) within 10° of the macula, fovea 2° and 4° fixation rates (P1, P2), 63% and 95% bivariate contour ellipse area (BCEA) were recorded. The comparison of MS, P1, P2, 63%BCEA and 95%BCEA at different times before and after surgery was performed by paired t test; the comparison of fixation stability rate was performed by χ² test. Results Compared with before surgery, there were significant differences in the improvement of MS in affected eyes at 1, 3 and 6 months after surgery (t=－2.208, －3.435,－4.919; P=0.038, 0.002, 0.000). In the pairwise comparison at different times after surgery, only 6 months after surgery and 1 month after surgery were significantly different (P=0.036). Compared with the preoperative P1, P2, 63%BCEA and 95%BCEA, the P1 and P2 of the eyes gradually increased after surgery, while the 63%BCEA and 95%BCEA gradually decreased, however, the difference was not statistically significant (P1: t=－1.595,－1.698,－1.966; P=0.125, 0.104, 0.062. P2: t=－1.622,－1.654,－1.707; P=0.119, 0.112, 0.102. 63%BCEA: t=1.410, 1.409, 1.553; P=0.172, 0.173, 0.135. 95%BCEA: t=1.412, 1.408, 1.564; P=0.172, 0.173, 0.132). Six months after surgery, all the eyes underwent anatomical repositioning of the macular area, and no serious complications such as full-thickness macular hole and macular hole retinal detachment were found. Conclusions PPV with internal limiting membrane peeling and air filling is an effective and safe method for MF, and the macular function improved significantly within 6 months postoperatively.

Citation： Yin Mingyang, Liu Yuyan, Han Quanhong. Macular functional changes after vitrectomy with internal limiting membrane peeling and air filling for myopic foveoschisis by microperimetry. Chinese Journal of Ocular Fundus Diseases, 2022, 38(4): 265-269. doi: 10.3760/cma.j.cn511434-20211111-00639 Copy

1.	Rizzo S, Giansanti F, Finocchio L, et al. Vitrectomy with internal limiting membrane peeling and air tamponade for myopic foveoschisis[J]. Retina, 2019, 39(11): 2125-2131. DOI: 10.1097/iae.0000000000002265.
2.	Dolar-Szczasny J, Święch-Zubilewicz A, Mackiewicz J. A review of current myopic foveoschisis management strategies[J]. Semin Ophthalmol, 2019, 34(3): 146-156. DOI: 10.1080/08820538.2019.1610180.
3.	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.
4.	何玉萍, 夏慧娟, 樊莹. 病理性近视黄斑劈裂的研究进展[J]. 国际眼科杂志, 2015, 15(1): 65-68. DOI: 10.3980/j.issn.1672-5123.2015.1.18.He YP, Xia HJ, Fan Y. Research progress of foveoschisis in pathological myopia[J]. Int Eye Sci, 2015, 15(1): 65-68. DOI: 10.3980/j.issn.1672-5123.2015.1.18.
5.	Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
6.	赵秀娟, 吕林. 努力加深对近视牵引性黄斑病变的认识, 合理开展手术治疗[J]. 中华眼底病杂志, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.Zhao XJ, Lyu L. Enhance the cognition of myopic traction maculopathy to select the surgical approach reasonably[J]. Chinese J Ocul Fundus Dis, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.
7.	Baptista PM, Silva N, Coelho J, et al. Microperimetry as part of multimodal assessment to evaluate and monitor myopic traction maculopathy[J]. Clin Ophthalmol, 2021, 15: 235-242. DOI: 10.2147/OPTH.S294662.
8.	应佳, 李俊, 徐格致, 等. 玻璃体切除联合内界膜剥除术治疗高度近视眼黄斑劈裂的疗效观察[J]. 中华眼科杂志, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.Ying J, Li J, Xu GZ, et al. Therapeutic effects of pars plana vitrectomy combined with internal limiting membrane peeling on high myopic foveoschisis[J]. Chin J Ophthalmol, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.
9.	朱丽, 陈晓, 晏颖, 等. 玻璃体切割联合内界膜完全剥除和保留中心凹内界膜剥除手术治疗高度近视黄斑劈裂的疗效比较[J]. 中华眼底病杂志, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.Zhu L, Chen X, Yan Y, et al 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[J]. Chinese J Ocul Fundus Dis, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.
10.	Wang L, Wang Y, Li Y, et al. Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis[J/OL]. Medicine (Baltimore), 2019, 98(9): e14710[2019-03-01]. https://pubmed.ncbi.nlm.nih.gov/30817612/. DOI: 10.1097/MD.0000000000014710.
11.	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.
12.	毛羽, 张风. 微视野计的临床应用[J]. 国际眼科纵览, 2010, 34(1): 61-64. DOI: 10.3706/cma.j.issn1673-5803.2010.01.015.Mao Y, Zhang F. The clinical application of micro-perimeter[J]. Int Rev Ophthalmol, 2010, 34(1): 61-64. DOI: 10.3706/cma.j.issn1673-5803.2010.01.015.
13.	Scupola A, Tiberti AC, Sasso P. Macular functional changes evaluated with MP-1 microperimetry after intravitreal bevacizumab for subfoveal myopic choroidal neovascularization: one-year results[J]. Retina, 2010, 30(5): 739-747. DOI: 10.1097/IAE.0b013e3181c59725.
14.	郭海霞, 楚艳华, 刘玉燕, 等. 病理性近视眼黄斑区微视野分析[J]. 中国实用眼科杂志, 2015, 33(5): 471-475. DOI: 10.3760/cma.j.issn.1006-4443.2015.05.007.Guo HX, Chu YH, Liu YY, et al The macular function assessment in pathological myopia eyes by microperimetry[J]. Chin J Pract Ophthalmol, 2015, 33(5): 471-475. DOI: 10.3760/cma.j.issn.1006-4443.2015.05.007.
15.	徐吉, 魏璐, 俞素勤, 等. 病理性近视患者黄斑功能的微视野检查[J]. 中华眼底病杂志, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.Xu J, Wei L, Yu SQ, et al. Macular function of pathologic myopic retina evaluated by microperimetry[J]. Chin J Ocul Fundus Dis, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.
16.	师燕芸, 郑太, 段薇, 等. 病理性近视脉络膜新生血管患眼玻璃体腔注射康柏西普治疗前后的黄斑视功能评价[J]. 中华眼底病杂志, 2019, 35(2): 166-170. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.011.Shi YY, Zheng T, Duan W, et al. Evaluation of maeular visual funotion in patients with myopic choroidal neovascularization before and after intravitreal injecfion of conbercept[J]. Chin J Ocul Fundus Dis, 2019, 35(2): 166-170. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.011.
17.	Shinohara K, Shimada N, Takase H, et al. Functional and strctural outcomes after fovea-sparing internal limiting membrane peeling for myopic macular retinoschisis by microperimetry[J]. Retina, 2020, 40(8): 1500-1511. DOI: 10.1097/IAE.0000000000002627.
18.	Chen L, Wei Y, Zhou X, et al. Morphologic, biomechanical, and compositional features of the internal limiting membrane in pathologic myopic foveoschisis[J]. Invest Ophthalmol Vis Sci, 2018, 59(13): 5569-5578. DOI: 10.1167/iovs.18-24676.
19.	Vogt D, Stefanov S, Guenther SR, et al. Comparison of vitreomacular interface changes in myopic foveoschisis and idiopathic epiretinal membrane foveoschisis[J]. Am J Ophthalmol, 2020, 217: 152-161. DOI: 10.1016/j.ajo.2020.04.023.
20.	Molina-Martín A, Pérez-Cambrodí RJ, Piñero DP. Current clinical application of microperimetry: a review[J]. Semin Ophthalmol, 2017, 33(5): 620-628. DOI: 10.1080/08820538.2017.1375125.
21.	Mao X, You Z, Cheng Y. Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study[J]. Exp Ther Med, 2019, 18(1): 589-595. DOI: 10.3892/etm.2019.7610.

1. Rizzo S, Giansanti F, Finocchio L, et al. Vitrectomy with internal limiting membrane peeling and air tamponade for myopic foveoschisis[J]. Retina, 2019, 39(11): 2125-2131. DOI: 10.1097/iae.0000000000002265.
2. Dolar-Szczasny J, Święch-Zubilewicz A, Mackiewicz J. A review of current myopic foveoschisis management strategies[J]. Semin Ophthalmol, 2019, 34(3): 146-156. DOI: 10.1080/08820538.2019.1610180.
3. 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.
4. 何玉萍, 夏慧娟, 樊莹. 病理性近视黄斑劈裂的研究进展[J]. 国际眼科杂志, 2015, 15(1): 65-68. DOI: 10.3980/j.issn.1672-5123.2015.1.18.He YP, Xia HJ, Fan Y. Research progress of foveoschisis in pathological myopia[J]. Int Eye Sci, 2015, 15(1): 65-68. DOI: 10.3980/j.issn.1672-5123.2015.1.18.
5. Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
6. 赵秀娟, 吕林. 努力加深对近视牵引性黄斑病变的认识, 合理开展手术治疗[J]. 中华眼底病杂志, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.Zhao XJ, Lyu L. Enhance the cognition of myopic traction maculopathy to select the surgical approach reasonably[J]. Chinese J Ocul Fundus Dis, 2020, 36(12): 911-914. DOI: 10.3760/cma.j.cn511434-20201123-00579.
7. Baptista PM, Silva N, Coelho J, et al. Microperimetry as part of multimodal assessment to evaluate and monitor myopic traction maculopathy[J]. Clin Ophthalmol, 2021, 15: 235-242. DOI: 10.2147/OPTH.S294662.
8. 应佳, 李俊, 徐格致, 等. 玻璃体切除联合内界膜剥除术治疗高度近视眼黄斑劈裂的疗效观察[J]. 中华眼科杂志, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.Ying J, Li J, Xu GZ, et al. Therapeutic effects of pars plana vitrectomy combined with internal limiting membrane peeling on high myopic foveoschisis[J]. Chin J Ophthalmol, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.
9. 朱丽, 陈晓, 晏颖, 等. 玻璃体切割联合内界膜完全剥除和保留中心凹内界膜剥除手术治疗高度近视黄斑劈裂的疗效比较[J]. 中华眼底病杂志, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.Zhu L, Chen X, Yan Y, et al 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[J]. Chinese J Ocul Fundus Dis, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.
10. Wang L, Wang Y, Li Y, et al. Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis[J/OL]. Medicine (Baltimore), 2019, 98(9): e14710[2019-03-01]. https://pubmed.ncbi.nlm.nih.gov/30817612/. DOI: 10.1097/MD.0000000000014710.
11. 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.
12. 毛羽, 张风. 微视野计的临床应用[J]. 国际眼科纵览, 2010, 34(1): 61-64. DOI: 10.3706/cma.j.issn1673-5803.2010.01.015.Mao Y, Zhang F. The clinical application of micro-perimeter[J]. Int Rev Ophthalmol, 2010, 34(1): 61-64. DOI: 10.3706/cma.j.issn1673-5803.2010.01.015.
13. Scupola A, Tiberti AC, Sasso P. Macular functional changes evaluated with MP-1 microperimetry after intravitreal bevacizumab for subfoveal myopic choroidal neovascularization: one-year results[J]. Retina, 2010, 30(5): 739-747. DOI: 10.1097/IAE.0b013e3181c59725.
14. 郭海霞, 楚艳华, 刘玉燕, 等. 病理性近视眼黄斑区微视野分析[J]. 中国实用眼科杂志, 2015, 33(5): 471-475. DOI: 10.3760/cma.j.issn.1006-4443.2015.05.007.Guo HX, Chu YH, Liu YY, et al The macular function assessment in pathological myopia eyes by microperimetry[J]. Chin J Pract Ophthalmol, 2015, 33(5): 471-475. DOI: 10.3760/cma.j.issn.1006-4443.2015.05.007.
15. 徐吉, 魏璐, 俞素勤, 等. 病理性近视患者黄斑功能的微视野检查[J]. 中华眼底病杂志, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.Xu J, Wei L, Yu SQ, et al. Macular function of pathologic myopic retina evaluated by microperimetry[J]. Chin J Ocul Fundus Dis, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.
16. 师燕芸, 郑太, 段薇, 等. 病理性近视脉络膜新生血管患眼玻璃体腔注射康柏西普治疗前后的黄斑视功能评价[J]. 中华眼底病杂志, 2019, 35(2): 166-170. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.011.Shi YY, Zheng T, Duan W, et al. Evaluation of maeular visual funotion in patients with myopic choroidal neovascularization before and after intravitreal injecfion of conbercept[J]. Chin J Ocul Fundus Dis, 2019, 35(2): 166-170. DOI: 10.3760/cma.j.issn.1005-1015.2019.02.011.
17. Shinohara K, Shimada N, Takase H, et al. Functional and strctural outcomes after fovea-sparing internal limiting membrane peeling for myopic macular retinoschisis by microperimetry[J]. Retina, 2020, 40(8): 1500-1511. DOI: 10.1097/IAE.0000000000002627.
18. Chen L, Wei Y, Zhou X, et al. Morphologic, biomechanical, and compositional features of the internal limiting membrane in pathologic myopic foveoschisis[J]. Invest Ophthalmol Vis Sci, 2018, 59(13): 5569-5578. DOI: 10.1167/iovs.18-24676.
19. Vogt D, Stefanov S, Guenther SR, et al. Comparison of vitreomacular interface changes in myopic foveoschisis and idiopathic epiretinal membrane foveoschisis[J]. Am J Ophthalmol, 2020, 217: 152-161. DOI: 10.1016/j.ajo.2020.04.023.
20. Molina-Martín A, Pérez-Cambrodí RJ, Piñero DP. Current clinical application of microperimetry: a review[J]. Semin Ophthalmol, 2017, 33(5): 620-628. DOI: 10.1080/08820538.2017.1375125.
21. Mao X, You Z, Cheng Y. Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study[J]. Exp Ther Med, 2019, 18(1): 589-595. DOI: 10.3892/etm.2019.7610.

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Macular functional changes after vitrectomy with internal limiting membrane peeling and air filling for myopic foveoschisis by microperimetry

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