1
|
Deng J, Sun WT, Gong K, Wang LP, Li FZ. Internal limiting membrane peeling combined with silicone oil or air tamponade for highly myopic foveoschisis. Int J Ophthalmol 2024; 17:1079-1085. [PMID: 38895672 PMCID: PMC11144761 DOI: 10.18240/ijo.2024.06.13] [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: 03/15/2023] [Accepted: 04/05/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To compare the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) and silicone oil or sterile air tamponade for the treatment of myopic foveoschisis (MF) in highly myopic eyes. METHODS This retrospective study included 48 myopic eyes of 40 patients with MF and axial lengths (ALs) ranging from 26-32 mm treated between January 2020 and January 2022. All patients were underwent PPV combined with ILM peeling followed by sterile air or silicone oil tamponade and followed up at least 12mo. Based on the features on spectral-domain optical coherence tomography (SD-OCT), the eyes were divided into the MF-only group (Group A, n=15 eyes), MF with central foveal detachment group (Group B, n=20 eyes), and MF with lamellar macular hole group (Group C, n=13 eyes). According to AL, eyes were further divided into three groups: Group D (26.01-28.00 mm, n=12 eyes), Group E (28.01-30.00 mm, n=26 eyes), and Group F (30.01-32.00 mm, n=10 eyes). The best-corrected visual acuity (BCVA), central foveal thickness (CFT), and complications were recorded. RESULTS The patients included 16 males and 24 females with the mean age of 56±9.82y. The BCVA and CFT improved in all groups after surgery (P<0.01), while there was no significant difference of the CFT in Group A, B, and C postoperatively (P>0.05). The intergroup differences of BCVA and CFT postoperatively were statistically significant in Group D, E, and F. Twenty eyes were injected with sterile air, and 28 eyes were injected with silicone oil for tamponade based on the AL. However, there was no statistically significant difference among Groups D, E, and F in terms of the results of sterile air or silicone oil tamponade. The mean recovery time was 5.9mo for MF patients subjected to silicone oil tamponade and 7.7mo for patients subjected to sterile air tamponade, and the difference was not statistically significant. CONCLUSION PPV and ILM peeling combined with silicone oil or sterile air tamponade can achieve good results for MF in highly myopic eyes with ALs≤32 mm.
Collapse
Affiliation(s)
- Jin Deng
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 70004, Shaanxi Province, China
| | - Wen-Tao Sun
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 70004, Shaanxi Province, China
| | - Ke Gong
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 70004, Shaanxi Province, China
| | - Li-Ping Wang
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 70004, Shaanxi Province, China
| | - Feng-Zhi Li
- Xi'an People's Hospital (Xi'an Fourth Hospital), Shaanxi Eye Hospital, Affiliated People's Hospital of Northwest University, Xi'an 70004, Shaanxi Province, China
| |
Collapse
|
2
|
Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, Lima-Gomez V. Novel surgical approaches for treating myopic traction maculopathy: a meta-analysis. BMC Ophthalmol 2024; 24:105. [PMID: 38443856 PMCID: PMC10913604 DOI: 10.1186/s12886-024-03374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM. METHODS To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1. RESULTS Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group. CONCLUSION Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary. TRIAL REGISTRATION Retrospectively registered.
Collapse
Affiliation(s)
- Miguel A Quiroz-Reyes
- Oftalmologia Integral ABC, Retina Department, Medical and Surgical Assistance Institution (Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Lomas de Chapultepec, Lomas de Chapultepec, Mexico City, 11000, Mexico.
| | - Erick A Quiroz-Gonzalez
- Oftalmologia Integral ABC, Retina Department, Medical and Surgical Assistance Institution (Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Lomas de Chapultepec, Lomas de Chapultepec, Mexico City, 11000, Mexico
- Institute of Ophthalmology, Chimalpopoca 14, 06800, Mexico City, Colonia Obrera, Mexico
| | - Miguel A Quiroz-Gonzalez
- Oftalmologia Integral ABC, Retina Department, Medical and Surgical Assistance Institution (Nonprofit Organization) affiliated with the Postgraduate Studies Division at the National Autonomous University of Mexico, Lomas de Chapultepec, Lomas de Chapultepec, Mexico City, 11000, Mexico
| | - Virgilio Lima-Gomez
- Juarez Hospital, Colonia Magdalena de Las Salinas, Av. Politecnico Nacional 5160, 07760, Mexico City, Mexico
| |
Collapse
|
3
|
Polito A, Garruto G, Maggio E, Mete M, Guerriero M, Pertile G. Fovea-sparing internal limiting membrane peeling with inverted flap technique versus standard internal limiting membrane peeling for symptomatic myopic foveoschisis. Sci Rep 2024; 14:2460. [PMID: 38291124 PMCID: PMC10828410 DOI: 10.1038/s41598-024-53097-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/27/2024] [Indexed: 02/01/2024] Open
Abstract
To study the long-term outcomes of standard ILM peeling and fovea sparing with inverted flap (FSIF) peeling for symptomatic myopic foveoschisis (MF). This retrospective observational study included 36 eyes of 34 consecutive patients who underwent vitrectomy with standard ILM peeling and FSIF peeling for MF between April 2012 and march 2020. The primary outcome measures included best-corrected visual acuity (BCVA) and central foveal thickness (CFT) at 1 month and final visit and postoperative development of macular hole. There were 14 eyes in the standard ILM peeling group and 22 eyes and in the FSIF peeling groups with a mean FU of 34.2 months (SD 23.3; min. 12-max. 96) and 27.7 months (SD 14.9; min. 12-max. 63), respectively. In both groups BCVA was not significantly improved at 1 month but improved at last visit from 0.55 ± 0.21 to 0.37 ± 0.29 in the standard ILM peeling group (P = 0.0154) and from 0.57 ± 0.27 to 0.28 ± 0.23 in the FSIF peeling group (P < 0.0001). At 1 month and final visit CMT decreased from 572 ± 183.5 µm to 277.5 ± 95.2 µm and to 250.4 ± 96.1 µm, respectively, in the standard ILM peeling group and from 589.9 ± 189.8 µm to 383 ± 110.1 µm and 162.3 ± 74.8 µm in the FSIF peeling group (P < 0.001 for both groups at both time-points). The preoperative and postoperative BCVA and CMT showed no significant differences between groups. Three of the eyes in the standard ILM peeling group developed postoperative macular hole at 1, 10, 24 months, respectively, and none of the eyes in the FSIF peeling group. Multivariate analysis revealed that a better BCVA was the only independent factor correlated with the final BCVA. In this study, standard ILM peeling and FSIF peeling were both beneficial in improving the anatomy and function of eyes with MF. Postoperative MH may occur up to 2 years after standard peeling and seem effectively prevented by FSIF peeling.
Collapse
Affiliation(s)
- Antonio Polito
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5-Negrar, 37024, Verona, Italy.
| | - Giulio Garruto
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5-Negrar, 37024, Verona, Italy
| | - Emilia Maggio
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5-Negrar, 37024, Verona, Italy
| | - Maurizio Mete
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5-Negrar, 37024, Verona, Italy
| | - Massimo Guerriero
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5-Negrar, 37024, Verona, Italy
- Department of Cultures and Civilizations, University of Verona, 37134, Verona, Italy
| | - Grazia Pertile
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5-Negrar, 37024, Verona, Italy
| |
Collapse
|
4
|
Chi K, Li B, Huang H, Sun J, Zheng Y, Zhao L. Exploring the Research Landscape of High Myopia: Trends, Contributors, and Key Areas of Focus. Med Sci Monit 2023; 29:e941670. [PMID: 38111192 PMCID: PMC10748438 DOI: 10.12659/msm.941670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/29/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Myopia results when light rays focus before reaching the retina, causing blurred vision. High myopia (HM), defined by a refractive error of ≤-6 diopters (D) or an axial length of ≥26 mm, is an extreme form of this condition. The progression from HM to pathological myopia (PM) is marked by extensive ocular axis elongation. The rise in myopia has escalated concerns for HM due to its potential progression to pathological myopia. The covert progression of HM calls for thorough analysis of its current research landscape. MATERIAL AND METHODS HM-related publications from 2003-2022 were retrieved from the Web of Science database. Using VOSviewer and Citespace software, we conducted a bibliometric and visualized analysis to create document co-citation network maps. These maps detailed authors, institutions, countries, key terms, and significant literature. RESULTS From 9,079 articles, 8,241 were reviewed. An increasing trend in publications was observed, with Kyoko Ohno-Matsui identified as a top contributor. The Journal of Cataract and Refractive Surgery was the primary publication outlet. Chinese researchers and institutions were notably active. The document citation network identified five focal areas: refractive surgery, clinical manifestations/treatment, prevention/control, genetics, and open angle glaucoma. CONCLUSIONS Research emphasis in HM has shifted from refractive surgery for visual acuity enhancement to the diagnosis, classification, prevention, and control of HM complications. Proposals for early myopia intervention to prevent HM are gaining attention. Genetics and HM's link with open angle glaucoma, though smaller in focus, significantly enhance our understanding of HM.
Collapse
Affiliation(s)
- Kaiyao Chi
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Biao Li
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Hui Huang
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Jianhao Sun
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Yanlin Zheng
- Department of Ophthalmology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, PR China
| | - Lei Zhao
- Department of Ophthalmology, The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, PR China
| |
Collapse
|
5
|
Zhang Y, Tang W, Liang J, Zhou X, Chen S, Zhi Z. Spontaneously Myopic Guinea Pig: Model of Early Pathologic Myopia. Invest Ophthalmol Vis Sci 2023; 64:19. [PMID: 37962527 PMCID: PMC10653258 DOI: 10.1167/iovs.64.14.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Purpose To evaluate whether pigmented guinea pigs with spontaneous myopia present characteristic changes of pathologic myopia. Methods The fundus images of guinea pigs (3 weeks old) were graded according to fundus tessellation (FT) degree. Biometric parameters, including refraction, vitreous chamber depth (VCD), and axial length (AL), were measured at ages 21 and 43 days. Some of these animals were divided into three groups: hyperopic without FT (H w/o FT), myopic without FT (M w/o FT), and myopic with FT (M w/ FT). The horizontal and vertical radii of curvature of posterior sclera (RP-H and RP-V, respectively) and the radii of curvature and arc lengths of superior sclera (RS and LS, respectively), inferior sclera (RI and LI, respectively), nasal sclera (RN and LN, respectively), and temporal sclera (RT and LT) were evaluated by Fuji. Results The fundi were graded as type A or type B (both without FT), type C (mild FT), or type D (severe FT). The prevalence of FT was correlated with myopic refraction, longer VCD, and longer AL. Eyes of M w/FT animals had shorter RP-H and RP-V, longer RS and RT, and longer LS and LT than eyes of H w/o FT or M w/o FT animals. Refractions shifted toward hyperopia in eyes lacking FT, but not in eyes having FT. The changes in VCD were consistent with the changes in refraction. This relatively myopic shift in refraction and shortening of VCD were found only in myopic eyes with FT, but not in myopic eyes without FT. Conclusions Spontaneously myopic guinea pig eyes have a high prevalence of FT. Myopic eyes with FT presented characteristic signs of pathologic myopia.
Collapse
Affiliation(s)
- Yue Zhang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, Wenzhou, Zhejiang, China
| | - Wenyu Tang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, Wenzhou, Zhejiang, China
| | - Jianqiang Liang
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, Wenzhou, Zhejiang, China
| | - Xiangtian Zhou
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, Wenzhou, Zhejiang, China
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou, Zhejiang, China
| | - Si Chen
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, Wenzhou, Zhejiang, China
| | - Zhina Zhi
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences, Wenzhou, Zhejiang, China
| |
Collapse
|
6
|
Wakabayashi T, Shiraki N, Tsuboi K, Oshima Y, Abe K, Yamamoto Y, Hisashi F, Baba K, Ishida Y, Otsuka Y, Shiraki A, Suzue M, Hashimoto R, Venkatesh R, Chhablani J, Gomi F, Kamei M, Maeno T, Regillo CD, Yonekawa Y, Ikuno Y. Risk Factors and Outcomes of Postoperative Macular Hole Formation after Vitrectomy for Myopic Traction Maculopathy: SCHISIS Report No. 2. Ophthalmol Retina 2023; 7:779-787. [PMID: 37257585 DOI: 10.1016/j.oret.2023.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE To evaluate the incidence, pathogenesis, risk factors, and treatment outcomes of postoperative macular hole (MH) after pars plana vitrectomy (PPV) for myopic traction maculopathy (MTM). DESIGN Multicenter, interventional, retrospective case series. SUBJECTS Consecutive eyes that underwent PPV for MTM with a minimum 6-month follow-up. METHODS We investigated the characteristics and treatment outcomes of postoperative MH after MTM surgery. MAIN OUTCOME MEASURES Incidence, risk factors, and anatomic and visual outcomes of postoperative MH. RESULTS We included 207 eyes (207 patients) with a mean follow-up of 25.9 months. During follow-up, 24 (11.6%) eyes developed MH (10 with concurrent MH retinal detachment); 15 eyes within 30 days (early), 4 eyes between 31 and 180 days (intermediate), and 5 eyes after 180 days (late). Logistic regression analysis revealed male gender (odds ratio [OR], 2.917; 95% confidence interval [CI], 1.198-7.100; P = 0.018), thinner preoperative choroidal thickness (OR, 0.988; 95% CI, 0.976-1.000; P = 0.048), and use of indocyanine green for internal limiting membrane peeling (OR, 2.960; 95% CI, 1.172-7.476; P = 0.022) as significant risk factors for postoperative MH. Internal limiting membrane peeling with a fovea-sparing technique tended to protect against postoperative MH, but it was not statistically significant (P = 0.096), because 1 eye still developed MH. Postoperative MHs were treated by observation (6 eyes), in-office octafluoropropane (C3F8) gas injection (7 eyes), or PPV (11 eyes). Macular hole closure was achieved in 20 eyes (83%). The hole closure rate was 67% (4/6 eyes) after observation, 71% (5/7 eyes) after C3F8 gas injection, and 91% (10/11 eyes) after PPV. However, visual outcomes were significantly worse for eyes with postoperative MH than those without (0.38 ± 0.43 vs. 0.68 ± 0.46; P = 0.002). CONCLUSIONS Postoperative MH may occur in 11.6% of patients with MTM at any time after surgery. Retreatment resulted in relatively favorable anatomic closure but unfavorable visual outcomes. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Taku Wakabayashi
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kotaro Tsuboi
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Yusuke Oshima
- Oshima Eye Clinic, Seiyukai Medical Corporation, Takatsuki, Osaka, Japan
| | - Kentaro Abe
- Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, Japan
| | - Yuki Yamamoto
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Fukuyama Hisashi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Keita Baba
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuichiro Ishida
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuki Otsuka
- Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, Japan
| | - Akihiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masaki Suzue
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryuya Hashimoto
- Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, Japan
| | - Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Rajaji Nagar, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Eye Center, Pittsburgh, Pennsylvania
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takatoshi Maeno
- Department of Ophthalmology, Toho University Sakura Medical Center, Sakura, Japan
| | - Carl D Regillo
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | |
Collapse
|
7
|
Zheng D, Huang Z, Chen W. Reply to comments on "Anatomical and visual outcomes of fovea-sparing internal limiting membrane peeling with or without inverted flap technique for myopic foveoschisis". BMC Ophthalmol 2023; 23:273. [PMID: 37316804 DOI: 10.1186/s12886-023-02986-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Dezhi Zheng
- Joint Shantou International Eye Center of Shantou University, Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, 515041, Shantou, Guangdong, P.R. China
| | - Zijing Huang
- Joint Shantou International Eye Center of Shantou University, Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, 515041, Shantou, Guangdong, P.R. China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University, Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, 515041, Shantou, Guangdong, P.R. China.
| |
Collapse
|
8
|
PROGRESSION OF MYOPIC MACULOPATHY IN PATIENTS WITH MYOPIC TRACTION MACULOPATHY AFTER VITRECTOMY. Retina 2023; 43:81-87. [PMID: 36223765 DOI: 10.1097/iae.0000000000003643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare the progression of myopic maculopathy with or without vitrectomy in patients with myopic traction maculopathy (MTM). METHODS Seventy-seven eyes with MTM were classified into either the observation group (n = 38) or the vitrectomy group (n = 39). Progression of myopic maculopathy was assessed with fundus photography using infrared images. Progression within stage was evaluated as an increase in the area of atrophic lesions on infrared images using ImageJ software. The rate of progression was compared using the paired t -test. RESULTS The mean follow-up period was 60.0 ± 47.5 months. The initial mean stage of myopic maculopathy for the observation group was 1.86 ± 0.86, and it progressed to 2.00 ± 0.83 ( P = 0.023) at the last visit. For the vitrectomy group, the stage progressed from 1.82 ± 0.96 to 2.05 ± 1.09 ( P = 0.011). Four eyes (10.5%) in the observation group showed progression at 87.3 months, and seven eyes (17.9%) in the vitrectomy group showed progression at 31.3 months. CONCLUSION Surgery in patients with MTM may accelerate the progression of myopic maculopathy. Therefore, care should be taken when considering surgery for patients with MTM.
Collapse
|
9
|
Zheng D, Huang Z, Zeng Q, Wang Y, Chen S, Yi J, Fang D, Huang D, Chen W. Anatomical and visual outcomes of fovea-sparing internal limiting membrane peeling with or without inverted flap technique for myopic foveoschisis. BMC Ophthalmol 2022; 22:444. [PMID: 36401229 PMCID: PMC9675137 DOI: 10.1186/s12886-022-02679-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vitrectomy and peeling of the internal limiting membrane (ILM) was an effective therapeutic approach for myopic foveoschisis with progressive visual loss. This study investigated the anatomical and visual outcomes of fovea-sparing ILM peeling with or without the inverted flap technique for patients with symptomatic myopic foveoschisis (MF). METHODS We retrospectively reviewed the clinical data of patients with MF. Vitrectomy with fovea-sparing ILM peeling and air tamponade was performed in all patients. The primary outcome measures included best-corrected visual acuity (BCVA), mean macular thickness (MMT), and central foveal thickness (CFT). Depending on whether an inverted ILM flap technique was utilized, further subgroup comparisons between the inverted flap group and the non-inverted flap group were conducted. RESULTS Twenty-six eyes of 22 patients were included. Fifteen eyes were underwent fovea-sparing ILM peeling without inverted ILM flap and 11 of the 26 eyes were treated with fovea-sparing ILM peeling and an inverted ILM flap technique. In the mean follow-up period of 10.74 ± 4.58 months, a significant improvement in BCVA was observed from 0.97 ± 0.45 logMAR to 0.58 ± 0.51 logMAR (P < 0.01), during which the BCVA of 20 eyes (76.92%) improved and remained stable in 5 eyes (19.23%). Moreover, a positive correlation was also found between the preoperative BCVA and the postoperative BCVA (r = 0.50, P = 0.01). At the last visit, the final MMT decreased from 492.69 ± 209.62 μm to 234.73 ± 86.09 μm, and the CFT reduced from 296.08 ± 209.22 μm to 138.31 ± 73.92 μm (all P < 0.01). A subgroup analysis found no significant differences in BCVA, MMT, or CFT between the inverted and non-inverted flap groups (all P > 0.05). CONCLUSION Fovea-sparing ILM peeling with or without inverted flap technique resulted in favorable visual and anatomical outcomes for the treatment of MF. An important factor affecting the postoperative visual outcome was the preoperative visual acuity. Our study found no significant difference between the presence and absence of the inverted ILM flap.
Collapse
Affiliation(s)
- Dezhi Zheng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Zijing Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Qin Zeng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Yifan Wang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Shirong Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Jingsheng Yi
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Danqi Fang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Dingguo Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, 69# North Dongxia Road, Jinping District, Shantou, Guangdong, 515041, P.R. China
| |
Collapse
|
10
|
Zhang J, Yu Y, Dai D, Liu W. Vitrectomy with internal limiting membrane peeling and gas tamponade for myopic foveoschisis. BMC Ophthalmol 2022; 22:214. [PMID: 35549885 PMCID: PMC9097353 DOI: 10.1186/s12886-022-02376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated the effect of vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade for myopic foveoschisis (MF), and analysed prognosis with different gas tamponade. Methods Retrospective, non-randomized study. The records of patients with MF treated by vitrectomy, were reviewed. Patients were followed up postoperatively mean 16.74 months, to record changes of Best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Results Sixty-two eyes (59 patients) were analysed in total, with mean age of 55.29 ± 10.34 years, 49 females (83.1%). Foveoschisis completely resolved in all eyes at least 6 months post vitrectomy, except for two postoperative full-thickness macular holes (FTMH). Final BCVA improved significantly from 0.69 ± 0.39 to 0.44 ± 0.42 logMAR, and CFT from 502.47 ± 164.78 to 132.67 ± 52.26 μm. Patients were subdivided into three subgroups based on the different endotamponades used (C3F8, C2F6, and air). Baseline BCVA, baseline CFT and foveal detachment (FD) were not significantly different among the three groups. Eyes treated with air tamponade had better visual outcomes than eyes with C3F8 tamponade (P = 0.008). Baseline BCVA and FD were significant risk factors for postoperative BCVA (P < 0.001 and P = 0.013, respectively). Conclusions Vitrectomy with ILM peeling and gas tamponade results in good functional and anatomic outcomes in the treatment of most MF. Good vision and no-FD pre-surgery are related with good visual prognosis. Air tamponade can provide as good visual recovery as expansive gas, and reduce postoperative complications.
Collapse
Affiliation(s)
- Jingyi Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Department of Ophthalmology, Cangzhou Central Hospital, Hebei, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Dongshu Dai
- Department of Ophthalmology, Cangzhou Central Hospital, Hebei, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China. .,Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
| |
Collapse
|
11
|
Outcomes of Vitrectomy with Fovea-Sparing and Inverted ILM Flap Technique for Myopic Foveoschisis. J Clin Med 2022; 11:jcm11051274. [PMID: 35268365 PMCID: PMC8911329 DOI: 10.3390/jcm11051274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Surgical treatment of myopic foveoschisis (MF) can result in a macular hole in 11−17% of patients that may lead to poor visual outcomes and progression to macular hole retinal detachment. We evaluated the benefit of vitrectomy to treat MF using the inverted internal limiting membrane (ILM) flap and fovea-sparing ILM techniques. We studied 20 eyes of 20 patients (7 men, 13 women) with high MF (mean axial length, 29.3 ± 1.7 mm). MF was classified by optical coherence tomography findings: retinoschisis (7 eyes) or foveal detachment (13 eyes). Between October 2013 and June 2021, we performed vitreous surgery in all 20 patients, employing both techniques. Air tamponade was used in 4 eyes, SF6 gas in 10 eyes, and C3F8 gas in 6 eyes. All patients stayed in the face-down position for one full day postoperatively. Visual acuity and foveal contour were analyzed using optical coherence tomography before surgery and at 3 and 6 months postoperatively. LogMAR visual acuity was 0.46 before surgery, with a significant improvement at 3 months (0.34) and at 6 months (0.2) postoperatively (p = 0.024, p < 0.001, respectively). In all patients, the foveal contour showed improvement without macular hole formation after surgery. These results show that vitrectomy, performed using the inverted ILM flap and fovea-sparing ILM technique, is effective for treating MF.
Collapse
|
12
|
Fovea sparing versus complete internal limiting membrane peeling for myopic traction maculopathy: a meta-analysis. Int Ophthalmol 2021; 42:765-773. [PMID: 34623570 DOI: 10.1007/s10792-021-02042-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Myopic traction maculopathy (MTM) is the leading cause of visual loss in high myopia. The purpose of this study was to compare the outcomes of pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane (ILM) peeling and complete ILM peeling for MTM. METHODS A comprehensive literature search was performed to find relevant studies. A meta-analysis was conducted by comparing the weighted mean differences (WMD) in the change of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) from baseline and calculating the odd ratios (OR) for rates of complete reattachment (CR) and postoperative macular hole (MH) formation. RESULTS Ten studies were selected, including 417 eyes (172 eyes in the fovea-sparing ILM peeling group (FSIP) and 245 eyes in complete ILM peeling group (CIP)). There was no significant difference in terms of mean change in CFT from baseline and the rate of CR(WMD = 3.53, 95% CI, -25.56 to 32.63, P = 0.81, and OR = 1.41, 95% CI, 0.81 to 2.44, P = 0.22). FSIP was superior to CIP in terms of mean change of logMAR BCVA post operation (WMD = -0.09, 95% CI, -0.15 to -0.03, P = 0.003), and associated with a significantly lower frequency of postoperative MH formation (OR = 0.19, 95% CI, 0.07 to 0.50, P = 0.0008). CONCLUSION FSIP resulted in similar anatomic outcomes compared to CIP, but resulted in better visual acuity and lower rates of postoperative MH development.
Collapse
|
13
|
Lin JP, Yang CM. Combined fovea-sparing internal limiting membrane peeling with internal limiting membrane flap technique for progressive myopic traction maculopathy. Graefes Arch Clin Exp Ophthalmol 2021; 260:489-496. [PMID: 34477928 DOI: 10.1007/s00417-021-05397-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/01/2021] [Accepted: 08/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To present the anatomical and functional outcomes of combined fovea-sparing internal limiting membrane peeling (FSIP) with internal limiting membrane flap (ILMF) for myopic traction maculopathy (MTM). METHODS This is a retrospective, observational study. Included were 66 eyes of 62 patients who underwent vitrectomy with combined FSIP and ILMF (or modified ILMF) for MTM with a minimal follow-up of 6 months. Thirty-one eyes were treated with FSIP, and 35 with modified ILMF. RESULTS The post-operative best-corrected visual acuity (BCVA) improved from 20/148 to 20/87 in the FSIP group (p < 0.001), and from 20/121 to 20/66 in the modified ILMF group (p < 0.001). The post-operative macular thickness (MT) reduced after FSIP (from 739.58 to 223.81 μm, p < 0.001) and modified ILMF (from 706.43 to 236.59 μm, p < .001). The degree of the improvement of BCVA and MT in both groups was insignificant. The incidence of a post-operative macular hole (MH) was 9.7% (3/31 eyes) with FSIP and 0% (0/35 eyes) with modified ILMF. All patients with a MH had foveoschisis in association with a lamellar hole (LMH) pre-operatively. After controlling the surgical technique, pre- and post-operative MT, follow-up duration, myopic atrophy maculopathy, and FD, the surgical technique showed significant effects on post-operative MH in all cases (p = 0.022) and in those with pre-operative LMH (p = 0.029). CONCLUSION Our pilot study showed both methods result in significant anatomical and functional improvement. The combined FSIP with ILMF method may prevent post-operative macular hole development in cases with MTM and LMH.
Collapse
Affiliation(s)
- Jih-Pin Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Yunlin, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Ophthalmology, College of Medicine, National Taiwan University, No. 7, Chun-Shan S. Rd., Taipei City, 100, Taiwan.
| |
Collapse
|
14
|
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. Ophthalmic Res 2021; 64:916-927. [PMID: 34425571 DOI: 10.1159/000519021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar macular hole (MH), and foveal retinal detachment. Pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane peeling (ILMP) has been developed to theoretically prevent postoperative MH formation and improve best-corrected visual acuity (BCVA) gain for MTM compared with the complete ILMP. However, in previous studies, the anatomic and visual outcomes still remain uncertain and controversial. OBJECTIVES The aim of this study was to evaluate the anatomic and visual outcomes of vitrectomy with fovea-sparing ILMP for the treatment of MTM compared with complete ILMP. METHODS Articles from PubMed, EMBASE, Web of Science, and Cochrane Library were systematically retrieved. The main outcomes were the rate of a postoperative MH and visual improvement of BCVA (converted to logarithm of the minimum angle of resolution [logMAR]). The secondary outcomes were the proportion of patients with visual improvement, the proportion of anatomic success, preoperative and postoperative BCVA, preoperative and postoperative central fovea thickness, and time to anatomic resolution. RESULTS There was a higher rate of postoperative MH formation (odds ratio [OR] 5.64; 95% confidence interval [CI]: 1.72-18.44; p = 0.004) and less improvement of BCVA in logMAR (mean difference [MD] -0.09; 95% CI: -0.18 to 0.00; p = 0.04) in the complete ILMP group. However, postoperative BCVA (MD 0.14; 95% CI: 0.00-0.27; p = 0.05), the proportion of patients with visual improvement (OR 0.39; 95% CI: 0.15-1.02; p = 0.05), postoperative central foveal thickness (MD -10.02; 95% CI: -24.4 to 4.36; p = 0.17), the rate of anatomic success (MD 0.39; 95% CI: 0.15-1.03; p = 0.06), and time to resolution (MD -1.65; 95% CI: -3.66 to 0.36; p = 0.11) showed no significant differences. CONCLUSION PPV combined with the fovea-sparing ILMP could contribute to a lower MH formation rate and more improvement of BCVA in logMAR than PPV combined with complete ILMP.
Collapse
Affiliation(s)
- Qiaozhu Zeng
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yuou Yao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Department of Ophthalmology, Eye Diseases and Optometry Institute, Peking University People's Hospital, Beijing, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| |
Collapse
|
15
|
Wang Y, Zhao X, Zhang W, Yang J, Chen Y. FOVEA-SPARING VERSUS COMPLETE INTERNAL LIMITING MEMBRANE PEELING IN VITRECTOMY FOR VITREOMACULAR INTERFACE DISEASES: A Systematic Review and Meta-Analysis. Retina 2021; 41:1143-1152. [PMID: 34001832 PMCID: PMC8140668 DOI: 10.1097/iae.0000000000003140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate fovea-sparing internal limiting membrane (ILM) peeling in vitrectomy compared with traditional complete ILM peeling in vitreomacular interface diseases, including macular hole (MH), epiretinal membrane, macular foveoschisis, myopic traction maculopathy, and the like. METHODS PubMed, EMBASE, Cochrane, CNKI Databases, and the ClinicalTrials.gov website (PROSPERO number CRD42020187401) were searched. Controlled trials comparing fovea-sparing with complete ILM peeling were included. Postoperative changes in best-corrected visual acuity, central retinal thickness in vitreomacular interface diseases, the incidence of MH closure in MH cases, full-thickness macular hole development in non-MH cases, and retinal reattachment in retinoschisis cases were extracted. RESULTS Fourteen studies (487 eyes) were eligible. Compared with complete ILM peeling, the fovea-sparing technique revealed significant improvement in best-corrected visual acuity ( logarithm of the minimum angle of resolution; weighted mean difference = -0.70; 95% confidence interval, -1.11 to -0.30), and a reduced incidence of full-thickness macular hole was noted in non-MH cases (risk ratios = 0.25; 95% confidence interval, 0.08-0.76). However, no significant differences in mean change in central retinal thickness, incidence of MH closure in MH cases, and retinal reattachment in retinoschisis cases were noted. CONCLUSION Based on current evidence, fovea-sparing ILM peeling significantly improve visual outcomes and decrease complications of full-thickness macular hole development in vitreomacular interface diseases.
Collapse
Affiliation(s)
- Yuelin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenfei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingyuan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
16
|
Azuma K, Hirasawa K, Araki F, Shiraya T, Yashiro S, Kato S, Nagahara M, Ueta T. Fovea-Sparing as Opposed to Total Peeling of Internal Limiting Membrane for Myopic Foveoschisis: A Systematic Review and Meta-analysis. Ophthalmol Retina 2020; 5:670-679. [PMID: 33307217 DOI: 10.1016/j.oret.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
TOPIC The effectiveness of fovea-sparing (FS) peeling of internal limiting membrane (ILM) to treat myopic foveoschisis (MF) has not been understood fully. The present meta-analysis aimed to compare postoperative visual and anatomic outcomes between FS peeling and total peeling (TP) of ILM in pars plana vitrectomy for the treatment of MF. CLINICAL RELEVANCE Postoperative macular hole (MH) development is not uncommon and is a serious complication after surgery for MF, with poor visual prognosis. Fovea-sparing peeling of ILM is expected to reduce the risk of postoperative MH; however, no statistically significant evidence exists to prove this hypothesis. In addition, its effect on postoperative visual acuity has not been clear. METHODS MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were reviewed systematically, and studies that compared FS with total ILM peeling in MF surgery were retrieved. The protocol was registered in International Prospective Register of Systematic Reviews (identifier, CRD42020201675). Primary outcome measures were the postoperative best-corrected visual acuity (BCVA) and frequency of postoperative MH development. Certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS Eight studies with 300 eyes from 289 patients were included. All studies were nonrandomized and observational. The postoperative BCVA was significantly better in eyes treated with FS (mean difference [MD], -0.15 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.24 to -0.05 logMAR; P = 0.002). The risk of postoperative MH was significantly lower in the FS group (odds ratio, 0.19; 95% CI, 0.06-0.56; P = 0.003). No significant difference was found in postoperative central foveal thickness (MD, 12.59 μm; 95% CI, -2.8 to 28.0 μm; P = 0.11). The certainty of evidence regarding lower frequency of postoperative MH after FS peeling was considered moderate, whereas the certainty regarding better postoperative BCVA after FS peeling was judged to be low. DISCUSSION Fovea-sparing peeling may contribute to better visual acuity outcome and lower risk of postoperative MH development in eyes with MF.
Collapse
Affiliation(s)
- Kunihiro Azuma
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazunori Hirasawa
- Orthoptics and Visual Science, School of Allied Health Science, Kitasato University, Kanagawa, Japan
| | - Fumiyuki Araki
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomoyasu Shiraya
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shigeko Yashiro
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kato
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Miyuki Nagahara
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Ueta
- Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan.
| |
Collapse
|
17
|
Wu J, Xu Q, Luan J. Vitrectomy with fovea-sparing ILM peeling versus total ILM peeling for myopic traction maculopathy: A meta-analysis. Eur J Ophthalmol 2020; 31:2596-2605. [PMID: 33143490 DOI: 10.1177/1120672120970111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the effect and safety of fovea-sparing internal limiting membrane (ILM) peeling (FSIP) for myopic traction maculopathy comparing with that of total ILM peeling (TP). METHODS PubMed, Web of science, Embase, Cochrane, EBSCO and CNKI, published until January 2020, were searched. Postoperative best-corrected visual acuity (BCVA), postoperative central foveal thickness (CFT), the rate of visual improvement and anatomic success were the main outcome parameters, and the secondary outcome parameters were postoperative complications. Random-effects models were chosen in regard with multi-studies. Standard mean difference (SMD) with 95% confidence interval (CI) and odds ratio (OR) were applied as effect sizes of continuous and binomial data, respectively. RESULTS Six comparative studies involving 193 eyes were included. Better postoperative BCVA was detected in the FSIP group (SMD = -0.39, 95%CI: -0.69 to -0.09, p = 0.01). The FSIP group had a higher rate of vision improvement with statistical significance (OR = 3.86, 95%CI: 1.36 to 10.97, p = 0.01). Both surgical methods had similar outcomes for postoperative CFT (SMD = 0.07, 95%CI: -0.27 to 0.40, p = 0.70). The FSIP group had a higher rate of anatomic success, though there was no obvious significance (OR = 2.54, 95%CI: 0.96 to 6.74, p = 0.06). For the development of postoperative full-thickness macular hole (FTMH), the rate was lower in the FSIP group (OR = 0.18, 95%CI: 0.05 to 0.64, p = 0.008). CONCLUSION Vitrectomy with fovea-sparing ILM peeling for myopic traction maculopathy could gain better visual outcomes and decrease incidence of FTMH development, though there was no obvious difference in postoperative CFT and the rate of anatomic success between two groups.
Collapse
Affiliation(s)
- Jingye Wu
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China.,School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Qian Xu
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| | - Jie Luan
- Department of Ophthalmology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| |
Collapse
|
18
|
Vogt D, Stefanov S, Guenther SR, Hagenau F, Wolf A, Priglinger SG, Schumann RG. Comparison of Vitreomacular Interface Changes in Myopic Foveoschisis and Idiopathic Epiretinal Membrane Foveoschisis. Am J Ophthalmol 2020; 217:152-161. [PMID: 32360335 DOI: 10.1016/j.ajo.2020.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare characteristics of the vitreomacular interface (VMI) in myopic foveoschisis (mFS) and idiopathic epiretinal membrane foveoschisis (iERM-FS), and to correlate with optical coherence tomography and clinical data. DESIGN Clinicopathologic study. METHODS Epiretinal membrane and internal limiting membrane (ILM) specimens were removed from eyes with mFS (5 eyes) and iERM-FS (5 eyes). Harvested tissue was processed for immunocytochemistry and prepared by ultrathin series sectioning for transmission electron microscopy. Cell and collagen compositions were compared and correlated with clinical data. RESULTS All eyes presented fibrocellular membranes irrespective if associated with mFS or iERM-FS. Cell and collagen types and distribution on the vitreal side of the ILM were similar in both groups, consistent with presence of tractional membranes on optical coherence tomography images. Immunostaining of all specimens were positive for glial cells, microglia, and hyalocytes. Electron microscopy revealed evidence of epiretinal cell multilayers with masses of vitreous collagen and signs of vitreous remodeling in both groups. Three eyes with mFS but none of the eyes with iERM-FS showed massive thinning of the ILM with prominent retinal undulations and presence of retinal nerve fiber layer fragments. CONCLUSION Whereas fibrocellular components of premacular tissue in mFS are similar to iERM-FS, pathologic abnormalities of the ILM were exclusively present in high myopia. Although peeling of the ILM appears important to completely remove tractional components of the VMI, histopathologic findings emphasize the risk for retinal damage in these highly myopic eyes, indicating that individual preoperative assessment and modification of surgical techniques require further investigation.
Collapse
Affiliation(s)
- Denise Vogt
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
| | - Stefan Stefanov
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Felix Hagenau
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
19
|
Ueta T, Makino S, Yamamoto Y, Fukushima H, Yashiro S, Nagahara M. Pathologic myopia: an overview of the current understanding and interventions. Glob Health Med 2020; 2:151-155. [PMID: 33330799 DOI: 10.35772/ghm.2020.01007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/17/2022]
Abstract
Pathologic myopia is a major cause of low vision and blindness worldwide. Its social and economic burden has been demonstrated by epidemiological studies. There have been recent advances in the classification system for myopic maculopathy that enables clinicians to describe different types of lesions, including tessellated fundus, diffuse/patchy chorioretinal atrophy, macular atrophy, lacquer cracks, choroidal neovascularization (CNV), and Fuchs' spot, in a standardized format. From a therapeutic point of view, anti-vascular endothelial growth factor therapy has been established as first-line choice for myopic CNV. For myopic retinoschisis and macular holes with/without retinal detachment, pars plana vitrectomy has been generally accepted as an efficient strategy. Studies are being conducted to determine how to avoid the development of a postoperative macular hole and to improve the quality of vision after surgery. In recent years, studies have revealed preventive measures that can be taken against myopia progression, including low-dose atropine eyedrops and contact lens wearing with peripheral myopic defocusing.
Collapse
Affiliation(s)
- Takashi Ueta
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - So Makino
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuuka Yamamoto
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Harumi Fukushima
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shigeko Yashiro
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Miyuki Nagahara
- Department of Ophthalmology, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Gui J, Ai L, Huang T. Vitrectomy with or without internal limiting membrane peeling for myopic foveoschisis. BMC Ophthalmol 2020; 20:83. [PMID: 32131776 PMCID: PMC7055105 DOI: 10.1186/s12886-020-01354-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background The aim of this study was to compare the anatomical and visual outcomes of vitrectomy with or without internal limiting membrane (ILM) peeling for symptomatic myopic foveoschisis (MF). Methods A retrospective cohort study of patients who had undergone vitrectomy for symptomatic MF at our specialist ophthalmology department in China. Cases were retrospectively categorized into one of two cohorts, depending on whether or not they had undergone ILM peeling (ILMP) during their surgery. Over a mean follow-up period of 18 months, all eyes underwent repeated examinations, including best-corrected visual acuity (BCVA) and optical coherence tomographic (OCT) recordings, particularly focusing on central foveal thickness (CFT), macular hole (MH) formation and/or foveal detachment (FD). Results We included 32 eyes (32 patients) with mean age of 62.2 ± 7.4 years. 31 patients (96.8%) were female. There were 21 eyes in the ILMP cohort and 11 eyes in the non-ILMP cohort. There were no significant preoperative differences in age, axial length, symptom duration or postoperative follow-up period between the two cohorts. MF was resolved completely in all of the eyes except one eye in the ILMP cohort. The postoperative CFT was significantly reduced compared to the preoperative baseline in both cohorts (469 ± 203 μm to 253 ± 56 μm; p = 0.003 in no-ILMP; 495 ± 178 μm to 244 ± 63 μm; p < 0.001 in ILMP, respectively). The final BCVA improved significantly in non-ILMP (1.27 ± 0.63 logMAR to 0.73 ± 0.55 logMAR; p = 0.021); but not significantly in ILMP cohort (1.25 ± 0.51 to 0.98 ± 0.57 logMAR; p = 0.143). Conclusion Vitrectomy, either with or without ILM peeling, results in a significant anatomical improvement in eyes with MF. Eyes treated by vitrectomy may have a better visual improvement when ILM was not peeled.
Collapse
Affiliation(s)
- Junmin Gui
- Department of Retinal & Vitreous Diseases, Chongqing Aier-Mega Eye Hospital, Aier Medical Group, 288 Nanchen Street, Chongqing, 400060, People's Republic of China.
| | - Ling Ai
- Department of Retinal & Vitreous Diseases, Chongqing Aier-Mega Eye Hospital, Aier Medical Group, 288 Nanchen Street, Chongqing, 400060, People's Republic of China
| | - Ting Huang
- Department of Retinal & Vitreous Diseases, Chongqing Aier-Mega Eye Hospital, Aier Medical Group, 288 Nanchen Street, Chongqing, 400060, People's Republic of China
| |
Collapse
|
21
|
Zhang T, Tang W, Xu G. Comparative Analysis of Three-Dimensional Heads-Up Vitrectomy and Traditional Microscopic Vitrectomy for Vitreoretinal Diseases. Curr Eye Res 2019; 44:1080-1086. [PMID: 31021174 DOI: 10.1080/02713683.2019.1612443] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To investigate the visual outcomes and occurrences of perioperative complications after three-dimensional (3D) heads-up vitrectomy compared with traditional microscopic (TM) surgery for vitreoretinal diseases. Methods: A retrospective case series comparison of 3D and TM vitrectomy performed on 124 and 202 eyes with a minimum follow-up of 6 months, respectively, by the same surgeon. Changes in visual acuity, primary anatomical success, operation time, and perioperative complications were evaluated. Results: There were no significant differences in age, gender, axial length, ocular and surgical history, surgical indication, and visual acuity between the two groups at baseline. Both groups showed a significant improvement in visual acuity at the final visit (both P < .05) and experienced comparable anatomical recoveries regarding epiretinal membranes, vitreous hemorrhage, macular holes, retinal detachment, and pathological myopic foveoschisis. The mean overall operation time was not significantly longer in the 3D group (31.0 ± 17.6 min) than the TM (31.0 ± 15.9 min) group (P = .994). The incidence rates of postoperative complications during the follow-up were similar between the 3D (30.6%) and TM groups (30.2%) (P = .932). Conclusions: The 3D and TM vitrectomy surgeries yielded comparable visual and anatomical outcomes for treatment of vitreoretinal diseases without a significant difference in the rate of complications. The 3D heads-up vitrectomy may be considered the treatment of choice for patients with various vitreoretinal diseases.
Collapse
Affiliation(s)
- Ting Zhang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai , China
| | - Wenyi Tang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai , China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai , China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University , Shanghai , China.,NHC Key Laboratory of Myopia, Fudan University , Shanghai , China.,Laboratory of Myopia, Chinese Academy of Medical Sciences , Shanghai , China
| |
Collapse
|
22
|
Dolar-Szczasny J, Święch-Zubilewicz A, Mackiewicz J. A Review of Current Myopic Foveoschisis Management Strategies. Semin Ophthalmol 2019; 34:146-156. [PMID: 31060414 DOI: 10.1080/08820538.2019.1610180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Myopic foveoschisis (MF) is common in highly myopic eyes with posterior staphyloma, and optical coherence tomography is essential for establishing the diagnosis and monitoring disease progression. Untreated MF may lead to significant visual loss due to secondary complications. Vitrectomy with or without internal limiting membrane peeling followed by gas tamponade is the standard treatment; however, in recent years, new techniques, including macular buckling, have been introduced. We selected a total of 41 articles with 30 describing various modifications of pars plana vitrectomy, six describing the macular buckling technique, and five reporting combined surgery. The present review describes current MF treatment strategies, including outcomes, and provides a comprehensive understanding of current therapeutic options. Early detection and surgical intervention in eyes with specific risk factors may contribute to both improved visual recovery and more favorable anatomical outcomes.
Collapse
Affiliation(s)
- Joanna Dolar-Szczasny
- a Department of Retina and Vitreous Surgery , Medical University of Lublin , Lublin , Poland
| | - Anna Święch-Zubilewicz
- a Department of Retina and Vitreous Surgery , Medical University of Lublin , Lublin , Poland
| | - Jerzy Mackiewicz
- a Department of Retina and Vitreous Surgery , Medical University of Lublin , Lublin , Poland
| |
Collapse
|
23
|
Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques. J Ophthalmol 2019; 2019:3230695. [PMID: 30984418 PMCID: PMC6432738 DOI: 10.1155/2019/3230695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/21/2019] [Indexed: 02/03/2023] Open
Abstract
Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.
Collapse
|