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Goudot M, Couturier A, Beaumont W, Gaudric A, Tadayoni R, Philippakis E. Retinal and Vitreous Changes Associated with Spontaneous Improvement in Myopic Macular Schisis. Ophthalmol Retina 2024:S2468-6530(24)00310-5. [PMID: 38950656 DOI: 10.1016/j.oret.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE To describe the retinal and vitreous changes in eyes showing myopic macular schisis (MMS) improvement when vitrectomy was not performed and identify triggering factors. DESIGN Retrospective observational study. SUBJECTS Patients with nonoperated MMS. METHODS The records of patients with MMS who were followed without performing surgery for >6 months were retrospectively reviewed, and the eyes showing an anatomic improvement were included. Myopic macular schisis evolution was analyzed quantitatively (central foveal thickness [CFT], parafoveal thickness, maximum height) and qualitatively (presence/absence of foveal detachment, lamellar hole, epiretinal membrane, choroidal neovascularization, inner and outer retinoschisis, vitreous status) at baseline and at the final visit. An anatomic improvement was defined as a decrease in CFT by ≥50 μm. MAIN OUTCOME MEASURES The rate of anatomic improvement of MMS without performing vitrectomy and the morphological changes observed in these cases. RESULTS In a cohort of 74 nonoperated eyes with MMS, MMS improved in 14 eyes (19%) after a mean follow-up of 55 ± 38 months (range, 8-138). In these improved cases, the mean decrease in CFT was 153 ± 166 μm (range, 24-635; P = 0.005) and a complete resolution of MMS was observed in 9 eyes (64%). In 9 eyes (64%), the improvement was associated with visible vitreous changes in the macular area on the OCT scans. The mean visual acuity, which was already good at baseline (20/50, 0.4 ± 0.2 logarithm of the minimum angle of resolution), increased at the last visit (20/40, 0.3 ± 0.3 logarithm of the minimum angle of resolution) but without reaching significance. CONCLUSIONS This long-term follow-up analysis showed that almost 20% of MMS in eyes without indication for surgery could improve over time. In most cases, the improvement was associated with an apparent resolution of vitreous tensions. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mathilde Goudot
- Université Paris Cité, Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
| | - Aude Couturier
- Université Paris Cité, Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
| | - William Beaumont
- Université Paris Cité, Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
| | - Alain Gaudric
- Université Paris Cité, Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
| | - Ramin Tadayoni
- Université Paris Cité, Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Paris, France; French Institute of Myopia, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Elise Philippakis
- Université Paris Cité, Ophthalmology Department, Assistance Publique - Hôpitaux de Paris, Hôpital Lariboisière, Paris, France; French Institute of Myopia, Hôpital Fondation Adolphe de Rothschild, Paris, France.
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Wakabayashi T, Tsuboi K, Oshima Y, Ishida Y, Baba K, Shiraki N, Yamamoto Y, Fukuyama H, Abe K, Otsuka Y, Hashimoto R, Shiraki A, Hara C, Venkatesh R, Chhablani J, Gomi F, Kamei M, Maeno T, Yonekawa Y, Ikuno Y. Efficacy of Vitrectomy With Tamponade Versus No Tamponade for Myopic Traction Maculopathy: A Multicenter Study (SCHISIS Report No.1). Am J Ophthalmol 2023; 254:182-192. [PMID: 37343740 DOI: 10.1016/j.ajo.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To evaluate the influence of tamponade on the visual and anatomic outcomes of pars plana vitrectomy for myopic traction maculopathy (MTM). DESIGN Multicenter, retrospective clinical cohort study. METHODS Consecutive eyes that underwent vitrectomy for advanced MTM with tamponade of air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) or without tamponade with a minimum follow-up of 12 months were included. Main outcome measures included postoperative visual acuity (VA) at 12 months in eyes with vs without tamponade. RESULTS We included a total of 193 eyes (193 patients) in this study; 136 eyes (70%) treated with tamponade were compared with 57 eyes (30%) treated without tamponade. Baseline characteristics did not differ significantly between the groups. Both groups showed significant visual improvement at 12 months (both P < .001). However, postoperative visual acuity and visual improvement at 12 months were significantly better (P = .003 and P = .028, respectively) in eyes without tamponade, although the MTM in these eyes without tamponade took longer to resolve (P = .039). Retinal thickness and the ellipsoid zone were more preserved in eyes without tamponade (P < .001 and P = .001, respectively). Complications such as macular holes did not differ between the groups. A novel imaging finding of "schisis bending (accordioning)" was identified during MTM resolution. CONCLUSIONS Vitrectomy either with or without tamponade for MTM was effective in improving vision in this study. However, eyes without tamponade experienced even better visual improvement and preserved retinal anatomy, despite a longer schisis resolution time. Surgery without tamponade may achieve better visual outcomes.
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Affiliation(s)
- Taku Wakabayashi
- From the Wills Eye Hospital (T.W., Y.Y.), Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Kotaro Tsuboi
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan; Casey Eye Institute (K.T.), Oregon Health & Science University, Portland, Oregon, USA
| | - Yusuke Oshima
- Oshima Eye Clinic (Y.O.), Seiyukai Medical Corporation, Takatsuki, Osaka, Japan
| | - Yuichiro Ishida
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan
| | - Keita Baba
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan
| | - Nobuhiko Shiraki
- Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuki Yamamoto
- Department of Ophthalmology (Y.Y., H.F. F.G.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hisashi Fukuyama
- Department of Ophthalmology (Y.Y., H.F. F.G.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Department of Ophthalmology (H.F.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kentaro Abe
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Yuki Otsuka
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Ryuya Hashimoto
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Akihiko Shiraki
- Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Chikako Hara
- Department of Ophthalmology (T.W., N.S., AS., C.H.), Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ramesh Venkatesh
- Department of Retina and Vitreous (R.V.), Narayana Nethralaya, Rajaji Nagar, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Department of Ophthalmology (J.C.), University of Pittsburgh Eye Center, Pittsburg, Pennsylvania, USA
| | - Fumi Gomi
- Department of Ophthalmology (Y.Y., H.F. F.G.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Motohiro Kamei
- Department of Ophthalmology (K.T., Y.I., K.B., M.K.), Aichi Medical University, Nagakute, Aichi, Japan
| | - Takatoshi Maeno
- Department of Ophthalmology (K.A., Y.O., R.H., T.M.), Toho University Sakura Medical Center, Sakura, Japan
| | - Yoshihiro Yonekawa
- From the Wills Eye Hospital (T.W., Y.Y.), Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022; 91:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
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