The efﬁcacy of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade in the treatment of myopic macular retinoschisis_Chinese Journal of Ocular Fundus Diseases

Authors：

Tao Jiwei , Yu Xueting ,  Shen Lijun , Chen Yiqi , Zhang Yun , Lin Li , Wu Hanfei

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

Corresponding author：

Shen Lijun, Email: slj@mail.eye.ac.cn

Keywords：

Retinoschisis/surgery; Myopia, degenerative/complications; Vitrectomy

DOI：

10.3760/cma.j.issn.1005-1015.2018.02.002

Video：

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Objective To observe the efﬁcacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF). Methods This is a retrospective case study. A total of 35 MF patients (36 eyes) were enrolled in this study. There were 5 males (5 eyes) and 30 females (31 eyes), with an average age of (60.13±10.00) years. All patients were examined for best corrected visual acuity (BCVA), diopter, optical coherence tomography (OCT) and axial length. The patients were divided into a MF group (group A, 10 eyes), MF with foveal detachment group (group B, 12 eyes) and MF with lamellar macular hole group (group C, 14 eyes) according to the OCT characteristics. There was no difference of age, gender, spherical equivalent refraction and axial length among 3 groups (F=0.020, 0.624, 0.009, 0.195; P＞0.05). There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100, 41.790; P＜0.05). All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade. The follow-up was more than one year. The BCVA and macular structure at the final follow-up were analyzed. The efficacy between 3 forms of MF was compared. Results At the final follow-up, the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm, which were significantly improved compared with preoperative measurements (t=5.984, 5.113; P＜0.001). MF was resolved in 33 eyes. In group A, B and C, the logMAR BCVA were 0.13±0.10, 0.73±0.33 and 0.38±0.52, respectively; CFT was (222.40±57.16), (212.50±150.45), (206.67±55.97) μm, respectively; MF was resolved in 10, 11 and 12 eyes, respectively; complete ellipsoid was observe in 8, 2 and 12 eyes. The logMAR BCVA (F=6.750, P=0.003) and the rate of complete ellipsoid (χ²=18.590, P＜0.001) in group B was lower than group A and C, the differences were significant. There was no difference of CFT (F=0.068, P=0.935) and the rate of MF resolving (χ²=1.558, P=0.459) among the three groups. One eye (1/14) in group C suffered from full layer macular hole. Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis. The macular structures and BCVA are worst in eyes with foveal detachment.

Citation： Tao Jiwei, Yu Xueting, Shen Lijun, Chen Yiqi, Zhang Yun, Lin Li, Wu Hanfei. The efﬁcacy of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade in the treatment of myopic macular retinoschisis. Chinese Journal of Ocular Fundus Diseases, 2018, 34(2): 111-115. doi: 10.3760/cma.j.issn.1005-1015.2018.02.002 Copy

1.	李楚, 郑文斌, 黄浩, 等. 高度近视黄斑劈裂治疗研究进展[J]. 中华眼底病杂志, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.Li C, Zhen WB, Huang H, et al. Progress in the treatment of myopic macular retinoschisis [J]. Chin J Ocul Fundus Dis, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.
2.	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, 2006, 143(3): 455-462. DOI: 10.1016/j.ajo.2006.10.053.
3.	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.
4.	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.
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.	Taniuchi S, Hirakata A, Itoh Y, et al. Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy[J]. Retina, 2013, 33(10): 2018-2025. DOI: 10.1097/IAE.0b013e3182a4892b.
7.	徐格致, 孙中萃. 关注高度近视黄斑劈裂玻璃体视网膜手术治疗效果的影响因素, 努力提升手术治疗效果[J]. 中华眼底病杂志, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.002.Xu GZ, Sun ZC.Pay attention to the influencing factor of vitrectomy outcome for the treatment of myopic foveoschisis[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.002.
8.	Sun CB, Liu Z, Xue AQ, et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye, 2010, 24 (12): 1787-1791. DOI: 10.1038/eye.2010.123.
9.	Uchida A, Shinoda H, Koto T, et al. Vitrectomy for myopic foveoschisis with internal limiting membrane peeling and no gas tamponade[J]. Retina, 2014, 34 (3): 455-460. DOI: 10.1097/IAE.0b013e3182a0e477.
10.	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.
11.	Kumagai K, Furukawa M, Ogino N, et al. Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Retina, 2010, 30(6): 874-880. DOI: 10.1097/IAE.0b013e3181c703fc.
12.	Wu TY, Yang CH, Yang CM. Gas tamponade for myopic foveoschisis with foveal detachment[J]. Graefe’s Arch Clin Exp Ophthalmol, 2012, 251(5): 1319-1324. DOI: 10.1007/s00417-012-2192-4.
13.	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.
14.	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.
15.	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.
16.	Gao X, Ikuno Y, Fujimoto S, et al. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol, 2013, 155(6): 1021-1027. DOI: 10.1016/j.ajo.2013.01.023.
17.	Wolf S, Schnurbusch U, Wiedemann P, et al. Peeling of the basal membrane in the human retina: ultrastructural effects[J]. Ophthalmology, 2004, 111(2): 238-243. DOI: 10.1016/j.ophtha.2003.05.022.
18.	Sayanagi K, Ikuno Y, Soga K, et al. Photoreceptor inner and outer segment defects in myopic foveoschisis[J]. Am J Ophthalmol, 2008, 145(5): 902-908. DOI: 10.1016/j.ajo.2008.01.011.
19.	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.
20.	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.
21.	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.
22.	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.
23.	Jin H, Zhang Q, Zhao P, et al. 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. 李楚, 郑文斌, 黄浩, 等. 高度近视黄斑劈裂治疗研究进展[J]. 中华眼底病杂志, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.Li C, Zhen WB, Huang H, et al. Progress in the treatment of myopic macular retinoschisis [J]. Chin J Ocul Fundus Dis, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.
2. 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, 2006, 143(3): 455-462. DOI: 10.1016/j.ajo.2006.10.053.
3. 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.
4. 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.
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. Taniuchi S, Hirakata A, Itoh Y, et al. Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy[J]. Retina, 2013, 33(10): 2018-2025. DOI: 10.1097/IAE.0b013e3182a4892b.
7. 徐格致, 孙中萃. 关注高度近视黄斑劈裂玻璃体视网膜手术治疗效果的影响因素, 努力提升手术治疗效果[J]. 中华眼底病杂志, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.002.Xu GZ, Sun ZC.Pay attention to the influencing factor of vitrectomy outcome for the treatment of myopic foveoschisis[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.002.
8. Sun CB, Liu Z, Xue AQ, et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye, 2010, 24 (12): 1787-1791. DOI: 10.1038/eye.2010.123.
9. Uchida A, Shinoda H, Koto T, et al. Vitrectomy for myopic foveoschisis with internal limiting membrane peeling and no gas tamponade[J]. Retina, 2014, 34 (3): 455-460. DOI: 10.1097/IAE.0b013e3182a0e477.
10. 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.
11. Kumagai K, Furukawa M, Ogino N, et al. Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Retina, 2010, 30(6): 874-880. DOI: 10.1097/IAE.0b013e3181c703fc.
12. Wu TY, Yang CH, Yang CM. Gas tamponade for myopic foveoschisis with foveal detachment[J]. Graefe’s Arch Clin Exp Ophthalmol, 2012, 251(5): 1319-1324. DOI: 10.1007/s00417-012-2192-4.
13. 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.
14. 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.
15. 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.
16. Gao X, Ikuno Y, Fujimoto S, et al. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol, 2013, 155(6): 1021-1027. DOI: 10.1016/j.ajo.2013.01.023.
17. Wolf S, Schnurbusch U, Wiedemann P, et al. Peeling of the basal membrane in the human retina: ultrastructural effects[J]. Ophthalmology, 2004, 111(2): 238-243. DOI: 10.1016/j.ophtha.2003.05.022.
18. Sayanagi K, Ikuno Y, Soga K, et al. Photoreceptor inner and outer segment defects in myopic foveoschisis[J]. Am J Ophthalmol, 2008, 145(5): 902-908. DOI: 10.1016/j.ajo.2008.01.011.
19. 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.
20. 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.
21. 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.
22. 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.
23. Jin H, Zhang Q, Zhao P, et al. 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

The efﬁcacy of pars plana vitrectomy with internal limiting membrane peeling and gas tamponade in the treatment of myopic macular retinoschisis

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