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Song S, He G, Huang D, Li X, Wu Z, Sun Y. Efficacy of pars plana vitrectomy combined with internal limiting membrane peeling and gas tamponade for treating myopic foveoschisis: a meta-analysis. BMC Ophthalmol 2024; 24:293. [PMID: 39026209 DOI: 10.1186/s12886-024-03534-2] [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: 10/20/2023] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate and explore the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and gas tamponade in treating myopic foveoschisis (MF) through a meta-analysis. METHODS Systematic searches were conducted on the PubMed, Web of Science and National Library of Medicine (NLM) English-language databases and the China National Knowledge Infrastructure (CNKI) and Wanfang Chinese-language databases. The primary outcome measures were postoperative best-corrected visual acuity (BCVA) and central foveal thickness (CFT), with the secondary outcome being the postoperative complication rate. Data analysis was performed using RevMan5.3 software. RESULTS A total of 10 studies involving 234 eyes were included. The meta-analysis results showed the following: (1) The average postoperative BCVA improved compared with preoperative levels, with an average improvement in the logarithm of the minimum angle of resolution of 0.40, a statistically significant difference (95% CI: -0.44, - 0.20, p < 0.001); (2) the rate of postoperative BCVA improvement was 77% (95% CI: 65%, 90%, p < 0.001); (3) the postoperative CFT significantly decreased by an average of 385.92 μm, a statistically significant difference (95% CI: -437.85, - 333.98, p < 0.001); (4) the postoperative macular retinal complete reattachment rate was 90% (95% CI: 83%, 97%, p < 0.001); (5) the most common postoperative complication was a cataract, with an incidence of 55.9%. CONCLUSION Using PPV combined with ILM peeling and gas tamponade to treat MF is reliable.
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Affiliation(s)
- Shuqi Song
- Department of Ophthalmology, The Hospital of Beijing Municipal Corps, Chinese people's Armed police Force, Northwest corner of Changhong Bridge Sanlitun, East Third Ring Road, Chaoyang District, Beijing, 100027, China
| | - Guanglun He
- Department of Ophthalmology, The Hospital of Beijing Municipal Corps, Chinese people's Armed police Force, Northwest corner of Changhong Bridge Sanlitun, East Third Ring Road, Chaoyang District, Beijing, 100027, China
| | - Di Huang
- Department of Ophthalmology, The Hospital of Beijing Municipal Corps, Chinese people's Armed police Force, Northwest corner of Changhong Bridge Sanlitun, East Third Ring Road, Chaoyang District, Beijing, 100027, China
| | - Xiaojuan Li
- Department of Ophthalmology, The Hospital of Beijing Municipal Corps, Chinese people's Armed police Force, Northwest corner of Changhong Bridge Sanlitun, East Third Ring Road, Chaoyang District, Beijing, 100027, China
| | - Zhenzhen Wu
- Department of Ophthalmology, The Hospital of Beijing Municipal Corps, Chinese people's Armed police Force, Northwest corner of Changhong Bridge Sanlitun, East Third Ring Road, Chaoyang District, Beijing, 100027, China
| | - Yongfeng Sun
- Department of Ophthalmology, The Hospital of Beijing Municipal Corps, Chinese people's Armed police Force, Northwest corner of Changhong Bridge Sanlitun, East Third Ring Road, Chaoyang District, Beijing, 100027, China.
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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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Surgical Outcomes of Myopic Foveoschisis According to the ATN Classification System. Ophthalmol Ther 2023; 12:71-85. [PMID: 36227418 PMCID: PMC9834482 DOI: 10.1007/s40123-022-00582-z] [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: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION This study compared the surgical outcomes in eyes with myopic foveoschisis (MF) according to the recently developed ATN classification system. METHODS This was an observational case series of 64 consecutive eyes that underwent vitrectomy for MF. Eyes were classified into severe myopic maculopathy (MM) (n = 43) and non-severe MM (n = 21) groups according to the ATN classification system. The primary outcome measures constituted best-corrected visual acuity (BCVA) and anatomical changes. RESULTS In total, BCVA improved from 0.97 to 0.53 (P < 0.001) after surgery. The ATN score was significantly lower in the eyes with vision improvement than those without vision improvement (P < 0.001). In the subgroup, BCVA improved from 0.79 to 0.28 in the non-severe MM group (P < 0.001), and improved from 1.05 to 0.65 in the severe MM group (P = 0.001) after surgery. The non-severe MM group achieved better postoperative BCVA (P = 0.001) and were more likely to gain vision improvement (P < 0.001) after surgery compared with the severe MM group. Anatomical success was achieved in 62 of the 64 eyes (96.88%). Two eyes with anatomical failure developed full-thickness macular holes postoperatively; both were in the severe MM group. CONCLUSIONS For patients with MF, different severity of MM based on ATN classification could lead to a significantly different prognosis after surgery. For patients with high ATN scores, the operative decision should be made cautiously for the worse anatomical and visual prognosis. ATN system is instructive in making operative proposals for MF.
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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.
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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
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Caporossi T, Governatori L, Gambini G, Baldascino A, De Vico U, Ripa M, Scampoli A, Carlà MM, Rizzo C, Kilian R, Rizzo S. Treatment of recurrent high myopic macular hole associated with retinal detachment using a human amniotic membrane. Jpn J Ophthalmol 2022; 66:518-526. [PMID: 36301445 DOI: 10.1007/s10384-022-00953-w] [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: 02/28/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the efficacy of using a human amniotic membrane to close macular hole retinal detachment in highly myopic eyes. STUDY DESIGN Prospective, consecutive, nonrandomized interventional study. METHODS We included 19 high myopic eyes from 19 patients affected by macular hole retinal detachment who had already undergone vitrectomy with internal limiting membrane peeling. The patients underwent vitrectomy with amniotic membrane transplant. RESULTS Primary success was achieved after 3 months in 89.5% (17 of 19 eyes) and final macular hole closure was obtained in 94.7% (18 of 19 eyes) of the patients. The final retinal reattachment rate was 100%. The final 12-month mean BCVA improved from 20/2000 (2 logMAR) to 20/250 (1.1 logMAR). OCT-angiography revealed a high correlation between the superficial and deep capillary plexus and the final BCVA. CONCLUSION Human amniotic membrane patches can effectively repair macular hole retinal detachment in high myopic eyes in terms of anatomic results and BCVA recovery.
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Affiliation(s)
- Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Lorenzo Governatori
- Department of Neurofarba, Ophthalmology, University of Florence, Florence, Italy.
| | - Gloria Gambini
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Umberto De Vico
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Scampoli
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Clara Rizzo
- Ophthalmology Unit, Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Pisa, Italy
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Feng J, Yu J, Chen Q, Zhou H, Chen F, Wang W, Xu X, Fan Y. Long-term surgical outcomes and prognostic factors of foveal detachment in pathologic myopia: based on the ATN classification. BMC Ophthalmol 2022; 22:175. [PMID: 35436918 PMCID: PMC9017033 DOI: 10.1186/s12886-022-02391-1] [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: 07/24/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the long-term surgical outcomes and prognostic factors of foveal detachment (FD) in pathological myopia. METHODS This retrospective observational study included 59 patients with FD (61 eyes) who underwent pars plana vitrectomy at Shanghai General Hospital between June 2017 and July 2018 with follow-up for at least 24 months. Comprehensive ophthalmic examinations, including best-corrected visual acuity (BCVA) and swept-source optical coherence tomography, were assessed. Preoperative myopic maculopathy was evaluated according to the ATN classification. RESULTS FD completely resolved in 59 of 61 eyes (96.7%). Mean duration of retinal reattachment was 12.10 ± 8.10 months. Mean logMAR BCVA improved from 1.34 ± 0.52 to 0.83 ± 0.43 at 24 months postoperatively (P < 0.001). Secondary macular hole occurred in 8 eyes (13.1%) with a mean period of 3.4 ± 4.1 weeks after primary surgery. In regression analyses, baseline myopic atrophy maculopathy (MAM) (B = 0.213, P = 0.005) and vitreomacular traction (VMT) (B = 0.292, P = 0.007) were adverse prognostic factors for postoperative BCVA. A more severe MAM revealed a delay in retinal reattachment (B = 5.670, P = 0.002). FD eyes with VMT (OR = 1.309, P = 0.003) or outer lamellar macular hole (O-LMH) (OR = 1.369, P < 0.001) were risk factors for postoperative secondary macular hole. CONCLUSIONS Vitrectomy was effective in the long-term for treating FD. Careful consideration is needed for those with VMT or O-LMH due to the high risk of secondary macular hole after vitrectomy. FD eyes with more severe MAM tended to have poorer postoperative BCVA and extended periods of retinal reattachment.
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Affiliation(s)
- Jingyang Feng
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jiayi Yu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Qiuying Chen
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Hao Zhou
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Fenge Chen
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Weijun Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Eye Diseases, Shanghai, China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Ying Fan
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,National Clinical Research Center for Eye Diseases, Shanghai, China. .,Shanghai Key Laboratory of Fundus Disease, Shanghai, China. .,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China. .,, No.85 Wujin Road, 200080, Shanghai, China.
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Fang D, Wang L, Chen L, Liang J, Li K, Mao X, Xie T, Zhang S. Vitreomacular Interface Abnormalities in Myopic Foveoschisis: Correlation With Morphological Features and Outcome of Vitrectomy. Front Med (Lausanne) 2022; 8:796127. [PMID: 35071276 PMCID: PMC8766811 DOI: 10.3389/fmed.2021.796127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To compare the morphologic characteristics and response to surgery of myopic foveoschisis (MF) with different patterns of vitreomacular interface abnormalities (VMIAs). Methods: In this observational case series, 158 eyes of 121 MF patients with epiretinal membrane (ERM) or vitreomacular traction (VMT) based on optical coherence tomography (OCT) were enrolled. All the eyes were divided into two groups by the pattern of VMIAs: ERM and VMT group. Sixty-one eyes underwent pars plana vitrectomy (PPV) and were followed up for at least 6 months. The morphologic characteristics based on OCT and the surgical outcome were evaluated. Outcome: ERM and VMT were found in 47.47 and 52.53% of the cases, respectively. A higher rate of foveal detachment (61.4 vs. 26.7%; p < 0.001) and a higher rate of outer lamellar macular hole (45.8 vs. 21.3%; p = 0.001) were detected in the eyes with VMT compared with those with ERM. In contrast, a lower rate of inner lamellar macular hole (28.9 vs. 60.0%; p = 0.001) was detected in the eyes with VMT compared with those with ERM. The disruption of the external limiting membrane (ELM) was more common in the eyes with VMT than in those with ERM (45.8 vs. 21.3%; p = 0.001). PPV was performed in 61 eyes with a mean follow-up time of 23.55 ± 19.92 months. After surgery, anatomical resolution was achieved in 51 eyes (83.6%). At the final visit, the mean central foveal thickness (CFT) decreased significantly from 547.83 to 118.74 μm, and the mean LogMAR BCVA improved significantly from 0.92 to 0.57. The VMT group was associated with a higher proportion of eyes with visual acuity improvement postoperatively (p = 0.02) and had more a decrease of CFT (P = 0.007) compared with the ERM group. Conclusion: In the eyes with MF, outer retinal lesions occurred more frequently in the eyes with VMT, whereas inner retinal lesions occurred more frequently in the eyes with ERM. Tangential force generated by ERM may act as a causative factor for the inner retinal lesions in MF, and inward-directed force resulting from VMT may act as a causative factor for outer retinal lesions in MF.
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Affiliation(s)
- Dong Fang
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen, China
| | - Li Wang
- Department of Ophthalmology, Chengdu Second People's Hospital, Chengdu, China
| | - Lu Chen
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen, China
| | - Jia Liang
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen, China
| | - Kunke Li
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen, China
| | - Xingxing Mao
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen, China
| | - Ting Xie
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen, China
| | - Shaochong Zhang
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Jinan University, Shenzhen, China
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Kong K, Xu S, Wang Y, Qi Y, Chang Q, Jiang R, Jiang C, Huang X, Gan D, Zhang Y, Chen L, Wang L, Luo X, Qin Y, Wu H, Zhou M, Ni Y, Xu G. Progression Patterns of Myopic Traction Maculopathy in the Fellow Eye After Pars Plana Vitrectomy of the Primary Eye. Invest Ophthalmol Vis Sci 2021; 62:9. [PMID: 34882205 PMCID: PMC8665302 DOI: 10.1167/iovs.62.15.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose This retrospective study investigated the patterns and risk factors of progression of myopic traction maculopathy (MTM) of fellow eyes after pars plana vitrectomy (PPV) of primary eyes. Methods The study population comprised 153 patients with MTM in both myopic eyes who sequentially underwent PPV (2006–2021). Observation periods were from PPV of the primary eye (baseline) to PPV of the fellow (end). MTM was graded based on optical coherence tomography (OCT) images and the ATN (atrophy [A], traction [T], and neovascularization [N]) system. An increase in T grade was considered MTM progression. Results MTM progressed in 43.8% of fellow eyes during 34.57 ± 34.08 months. The progression of fellow eyes correlated with T grade of primary eyes (P < 0.001). Risk factors for the progression of MTM in fellow eyes were primary eyes in T4–T5, age at baseline <60 years, and fellow eyes with partial posterior vitreous detachment (PVD; P < 0.001, P = 0.042, and P = 0.002, respectively). Fellow eyes in T1/T2 at baseline progressed faster compared with those in T0 (P < 0.001); the annual rate of progression to T3–T5 of the T0 (T1–T2) groups was 9.98% (24.59%). Conclusions Risk factors for the progression of MTM in fellow eyes included PPV when relatively young, primary eye at high T grade, and partial PVD of the fellow eye. Personalized follow-up for fellow eyes should be based on the severity of MTM of both eyes.
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Affiliation(s)
- Kangjie Kong
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Sisi Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Department of Ophthalmology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingchao Wang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Yuhe Qi
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Chunhui Jiang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Xin Huang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Dekang Gan
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Yanqiong Zhang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Ling Chen
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Ling Wang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Xiaogang Luo
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Yaowu Qin
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Haixiang Wu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Yingqin Ni
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
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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.
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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.
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Comparison of fovea-sparing and non-internal limiting membrane peeling for retinoschisis with foveal detachment in highly myopic eyes. Eye (Lond) 2020; 35:1467-1472. [PMID: 32709955 DOI: 10.1038/s41433-020-1108-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 07/06/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare the visual and anatomical outcomes of two different treatment strategies (non-internal limiting membrane (ILM) peeling and fovea-sparing ILM peeling) for retinoschisis with foveal detachment (FD) in highly myopic eyes. DESIGN A retrospective cohort study. METHODS Ninety-five eyes from 92 highly myopic patients with retinoschisis with FD were divided into two groups, including 44 eyes from 43 patients who received 23-gauge, 3-port vitrectomy without ILM peeling (group A) and 51 eyes from 49 patients who received vitrectomy with fovea-sparing ILM peeling (group B). All eyes also underwent cataract surgery. RESULTS There were no significant differences between the two groups in terms of sex, age, diopters, axial length (AL), or central foveal thickness (CFT) before surgery (P > 0.05). One month after surgery, foveoschisis and FD were resolved in 74.47% of the eyes in group B and in only 12.50% of those in group A. Six months after surgery, foveoschisis and FD were resolved in 96.08% of the eyes in group B and in only 72.73% of those in group A (P < 0.05). There were no significant differences between the two groups in terms of BCVA 6 months after surgery. The postoperative complication was macular holes, which were found in seven eyes (15.90%) in group A and in one eye (1.96%) in group B (P < 0.05). CONCLUSION Highly myopic eyes with FD that underwent fovea-sparing ILM peeling appeared to obtain a better anatomical outcome than those that did not undergo non-ILM peeling. The two procedures obtained similar results in terms of visual function.
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11
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Long-Term Outcome of Vitrectomy with Suitable Internal Limiting Membrane Peeling and Air Tamponade for Highly Myopic Foveoschisis-Associated Lamellar Macular Hole. J Ophthalmol 2020; 2020:2074037. [PMID: 32148935 PMCID: PMC7057024 DOI: 10.1155/2020/2074037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/11/2020] [Accepted: 01/30/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the outcome of pars plana vitrectomy (PPV) with suitable internal limiting membrane peeling (ILM) and air tamponade for patients with highly myopic foveoschisis-associated lamellar macular hole (MH). Methods This retrospective interventional case series included 11 patients with highly myopic foveoschisis-associated lamellar MH who underwent PPV and indocyanine green-aided ILM peeling up to the temporal vascular arcades. Following air tamponade after surgery, all patients were instructed to maintain a face-down position. The patients were followed up for over 1 year and evaluated for MH closure and the best-corrected visual acuity before and after surgery. Results The mean ± standard deviation values of patient age, axial length, and follow-up duration were 67.82 ± 6.54 years, 29.21 ± 1.95 mm, and 24.27 ± 8.11 months, respectively. After surgery, the lamellar MH closed in all eyes, and 10 eyes showed vision improvement at the 1-month, 3-month, and final follow-up evaluations. One patient showed decreased vision at 2 years after surgery, with patchy chorioretinal atrophy in the macular region. Myopic foveoschisis showed resolution in three eyes and alleviation in eight. Ten patients underwent cataract surgery during PPV. Conclusion Extension of ILM peeling up to the temporal vascular arcades and air tamponade after PPV may improve the visual function and rate of MH closure for patients with highly myopic foveoschisis-associated lamellar MH.
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12
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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.
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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
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Yi HC, Kim H, Bae SH. Long-term Outcomes of Vitrectomy Used to Treat Myopic Traction Maculopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ho Chul Yi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hakyoung Kim
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - So Hyun Bae
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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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.
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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
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