The necessity to protect against the risk of surgery-related macular hole formation in high myopia foveoschis surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

 Zhao Mingwei

Department of Ophthalmology, Peking University People′s Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing 100044, China;

Corresponding author：

Zhao Mingwei, Email: dr_zhaomingwei@163.com

Keywords：

Myopia, degenerative; Foveoschisis; Vitrectomy; Inner limiting membrane peeling; Silicone oil tamponade; Macular hole; Editorial

DOI：

10.3760/cma.j.cn511434-20220810-00446

Video：

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The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.

Citation： Zhao Mingwei. The necessity to protect against the risk of surgery-related macular hole formation in high myopia foveoschis surgery. Chinese Journal of Ocular Fundus Diseases, 2022, 38(9): 707-710. doi: 10.3760/cma.j.cn511434-20220810-00446 Copy

1.	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.
2.	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.
3.	Shimada N, Ohno-Matsui K, Baba T, et al. Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment[J]. Am J Ophthalmol, 2006, 142(3): 497-500. DOI: 10.1016/j.ajo.2006.03.048.
4.	Peng KL, Kung YH, Hsu CM, et al. Surgical outcomes of centripetal non-fovea-sparing internal limiting membrane peeling for myopic foveoschisis with and without foveal detachment: a follow-up of at least 3 years[J]. Br J Ophthalmol, 2020, 104(9): 1266-1270. DOI: 10.1136/bjophthalmol-2019-314972.
5.	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.
6.	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.
7.	Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800. DOI: 10.1016/s0002-9394(02)01394-6.
8.	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.
9.	VanderBeek BL, Johnson MW. The diversity of traction mechanisms in myopic traction maculopathy[J]. Am J Ophthalmol, 2012, 153(1): 93-102. DOI: 10.1016/j.ajo.2011.06.016.
10.	Kobayashi H, Kishi S. Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis[J]. Ophthalmology, 2003, 110: 1702-1707. DOI: 10.1016/S0161-6420(03)00714-0.
11.	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.
12.	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, 2019, 98(9): e14710[2019-03-01]. https://pubmed.ncbi.nlm.nih.gov/30817612/. DOI: 10.1097/MD.0000000000014710.
13.	Shiraki N, Wakabayashi T, Ikuno Y, et al. Fovea-sparing versus standard internal limiting membrane peeling for myopic traction maculopathy: a study of 102 consecutive cases[J]. Ophthalmol Retina, 2020, 4(12): 1170-1180. DOI: 10.1016/j.oret.2020.05.016.
14.	Lee CL, Wu WC, Chen KJ, et al. Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery[J/OL]. Acta Ophthalmol, 2017, 95(2): e128-131[2016-06-20]. https://pubmed.ncbi.nlm.nih.gov/27320761/. DOI: 10.1111/aos.13115.
15.	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.
16.	Figueroa MS, Ruiz-Moreno JM, Gonzalez del Valle F, et al. Long-term outcomes of 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for myopic traction maculopathy: a prospective study[J]. Retina, 2015, 35(9): 1836-1843. DOI: 10.1097/IAE.0000000000000554.
17.	Tian T, Jin H, Zhang Q, et al. Long-term surgical outcomes of multiple parfoveolar curvilinear internal limiting membrane peeling for myopic foveoschisis[J]. Eye (Lond), 2018, 32(11): 1783-1789. DOI: 10.1038/s41433-018-0178-0.
18.	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.
19.	Gass JD. Müller cell cone, an overlooked part of the anatomy of the fovea centralis: hypotheses concerning its role in the pathogenesis of macular hole and foveomacualr retinoschisis[J]. Arch Ophthalmol, 1999, 117(6): 821-823. DOI: 10.1001/archopht.117.6.821.
20.	Zeng Q, Yao Y, Zhao M. Comparison between fovea-sparing and complete internal limiting membrane peeling for the treatment of myopic traction maculopathy: a systemic review and meta-analysis[J]. Ophthalmic Res, 2021, 64(6): 916-927. DOI: 10.1159/000519021.
21.	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.
22.	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.
23.	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.
24.	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.
25.	Yao Y, Qu J, Shi X, et al. Vitrectomy with silicone oil tamponade and without internal limiting membrane peeling for the treatment of myopic foveoschisis with high risk of macular hole development[J/OL]. Front Med (Lausanne), 2021, 8: 648540[2021-05-28]. https://pubmed.ncbi.nlm.nih.gov/34124090/. DOI: 10.3389/fmed.2021.648540.

1. 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.
2. 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.
3. Shimada N, Ohno-Matsui K, Baba T, et al. Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment[J]. Am J Ophthalmol, 2006, 142(3): 497-500. DOI: 10.1016/j.ajo.2006.03.048.
4. Peng KL, Kung YH, Hsu CM, et al. Surgical outcomes of centripetal non-fovea-sparing internal limiting membrane peeling for myopic foveoschisis with and without foveal detachment: a follow-up of at least 3 years[J]. Br J Ophthalmol, 2020, 104(9): 1266-1270. DOI: 10.1136/bjophthalmol-2019-314972.
5. 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.
6. 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.
7. Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800. DOI: 10.1016/s0002-9394(02)01394-6.
8. 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.
9. VanderBeek BL, Johnson MW. The diversity of traction mechanisms in myopic traction maculopathy[J]. Am J Ophthalmol, 2012, 153(1): 93-102. DOI: 10.1016/j.ajo.2011.06.016.
10. Kobayashi H, Kishi S. Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis[J]. Ophthalmology, 2003, 110: 1702-1707. DOI: 10.1016/S0161-6420(03)00714-0.
11. 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.
12. 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, 2019, 98(9): e14710[2019-03-01]. https://pubmed.ncbi.nlm.nih.gov/30817612/. DOI: 10.1097/MD.0000000000014710.
13. Shiraki N, Wakabayashi T, Ikuno Y, et al. Fovea-sparing versus standard internal limiting membrane peeling for myopic traction maculopathy: a study of 102 consecutive cases[J]. Ophthalmol Retina, 2020, 4(12): 1170-1180. DOI: 10.1016/j.oret.2020.05.016.
14. Lee CL, Wu WC, Chen KJ, et al. Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery[J/OL]. Acta Ophthalmol, 2017, 95(2): e128-131[2016-06-20]. https://pubmed.ncbi.nlm.nih.gov/27320761/. DOI: 10.1111/aos.13115.
15. 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.
16. Figueroa MS, Ruiz-Moreno JM, Gonzalez del Valle F, et al. Long-term outcomes of 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for myopic traction maculopathy: a prospective study[J]. Retina, 2015, 35(9): 1836-1843. DOI: 10.1097/IAE.0000000000000554.
17. Tian T, Jin H, Zhang Q, et al. Long-term surgical outcomes of multiple parfoveolar curvilinear internal limiting membrane peeling for myopic foveoschisis[J]. Eye (Lond), 2018, 32(11): 1783-1789. DOI: 10.1038/s41433-018-0178-0.
18. 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.
19. Gass JD. Müller cell cone, an overlooked part of the anatomy of the fovea centralis: hypotheses concerning its role in the pathogenesis of macular hole and foveomacualr retinoschisis[J]. Arch Ophthalmol, 1999, 117(6): 821-823. DOI: 10.1001/archopht.117.6.821.
20. Zeng Q, Yao Y, Zhao M. Comparison between fovea-sparing and complete internal limiting membrane peeling for the treatment of myopic traction maculopathy: a systemic review and meta-analysis[J]. Ophthalmic Res, 2021, 64(6): 916-927. DOI: 10.1159/000519021.
21. 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.
22. 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.
23. 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.
24. 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.
25. Yao Y, Qu J, Shi X, et al. Vitrectomy with silicone oil tamponade and without internal limiting membrane peeling for the treatment of myopic foveoschisis with high risk of macular hole development[J/OL]. Front Med (Lausanne), 2021, 8: 648540[2021-05-28]. https://pubmed.ncbi.nlm.nih.gov/34124090/. DOI: 10.3389/fmed.2021.648540.

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The necessity to protect against the risk of surgery-related macular hole formation in high myopia foveoschis surgery

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