FUNCTIONAL AND STRUCTURAL OUTCOMES AFTER FOVEA-SPARING INTERNAL LIMITING MEMBRANE PEELING FOR MYOPIC MACULAR RETINOSCHISIS BY MICROPERIMETRY

Clinical utilization of microperimetry in ophthalmic surgery: A narrative review

Microperimetry is an emerging technology that provides concurrent analysis of retinal structure and function by combining retinal sensitivity and fixation analysis with fundus imaging. We summarize the substantial evidence validating the evolving role of microperimetry as an adjunctive assessment of visual function in the perioperative setting. We show that microperimetry provides useful complementary information to other established imaging and functional modalities in the perioperative setting for a wide range of vitreoretinal surgical procedures, as well as in cataract and refractive surgeries. This includes preoperative uses such as prognostication of visual and anatomical outcomes, timing of surgical intervention, and assessment of patient suitability for surgery-as well as postoperative uses including quantification of visual recovery, investigation of unexplained postoperative vision loss, and informing expected long term functional outcomes.

Microperimetry in Retinal Diseases

Retinal microperimetry (MP) is a procedure that assesses the retinal sensitivity while the fundus is directly observed, and an eye tracker system is active to compensate for involuntary eye movements during testing. With this system, the sensitivity of a small locus can be accurately determined, and it has become an established ophthalmic test for retinal specialists. Macular diseases are characterized by chorioretinal changes; therefore, the condition of the retina and choroid requires careful and detailed evaluations to perform effective therapy. Age-related macular degeneration is a representative retinal disease in which the macular function has been evaluated by the visual acuity throughout the course of the disease process. However, the visual acuity represents the physiological function of only the central fovea, and the function of the surrounding macular area has not been sufficiently evaluated throughout the different stages of the macula disease process. The new technique of MP can compensate for such limitations by being able to test the same sites of the macular area repeatedly. This is especially useful in the recent management of age-related macular degeneration or diabetic macular edema during anti-vascular endothelial growth factor treatments because MP can assess the effectiveness of the treatment. MP examinations are also valuable in diagnosing Stargardt disease as they can detect visual impairments before any abnormalities are found in the retinal images. The visual function needs to be carefully assessed along with morphologic observations by optical coherence tomography. In addition, the assessment of retinal sensitivity is useful in the presurgical or postsurgical evaluations.

Myopic Foveoschisis Completely Resolves within 12 Months after Vitrectomy

PURPOSE

To assess the sequence of anatomical resolution of myopic foveoschisis (MFS) after vitrectomy.

DESIGN

Monocentric retrospective observational case series.

SUBJECTS

The files of consecutive patients with MFS who underwent vitreoretinal surgery and were followed postoperatively for at least 6 months were reviewed.

METHODS

Patients underwent pars plana vitrectomy for MFS. The central foveal thickness (CFT) was measured. The presence of a foveal involvement, and/or outer retinoschisis (ORS), with or without inner retinoschisis (IRS), and foveal detachment (FD) were analyzed. Anatomical success was defined as the resolution of foveal ORS and FD.

MAIN OUTCOME MEASURES

The main outcome was the time to resolution of the different morphologic features of MFS after surgery.

RESULTS

Thirty-nine eyes of 36 patients were included in the analysis. The mean follow-up was 14.8 ± 12.9 months (range, 6-84 months). Anatomical success was achieved in 82% of cases at the end of the follow-up and in > 80% of cases during the first year. The CFT was significantly decreased in 79% of cases at 3 months. Inner retinoschisis, present in 18 eyes (46%), resolved in all cases after a median time of 1 month. Foveal ORS, present in all cases, resolved in 82% of cases after a median time of 3 months. The FD, present in 23 eyes (59%), resolved in 91% of cases after a median time of 6 months. Extrafoveal ORS resolved in 59% of cases after a median time of 12 months. The mean best-corrected visual acuity significantly improved from 0.80 ± 0.64 logarithm of the minimum angle of resolution (logMAR) (Snellen Eq 20/148) to 0.48 ± 0.52 logMAR (Snellen Eq 20/70).

CONCLUSIONS

Most MFS (80%) are completely resolved during the first year. The decrease in CFT and early resolution of IRS could be used as early biomarkers of surgical success.

Anatomical and visual outcomes of fovea-sparing internal limiting membrane peeling with or without inverted flap technique for myopic foveoschisis

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.

Outcomes of a new 3-D printing-assisted personalized macular buckle combined with para plana vitrectomy for myopic foveoschisis

PURPOSE

To describe and evaluate the application of a new 3-D printing-assisted personalized macular buckle for patients with myopic foveoschisis (MFS).

METHODS

Twelve eyes of 12 patients with MFS were included in this study. Preoperative MRI images were subsequently measured after marker implantation and imported into the MIMICS software for the 3-D reconstruction of a virtual model of an eyeball and a marker. The virtual eyeball model was designed according to the degree of retinoschisis, which was measured using optical coherence tomography preoperatively. A macular buckle was designed using a titanium stent, assisted by 3-D printing; furthermore, it was surgically placed in combination with pars plana vitrectomy. Visual acuity, axial length and anatomic outcomes were analysed pre- and postoperatively.

RESULTS

Macular schisis in all patients was completely resolved after the surgery without any postoperative complications. The mean postoperative best corrected visual acuity (LogMAR) improved significantly from 1.21 to 0.92 during the 6-month follow-up period (p < 0.001) and reached 0.9 (p < 0.001) after 2 years. The axial length was significantly shortened during the 2 years postoperatively follow-up period (p < 0.01). The average axial lengths in all patients decreased from 30.62 mm preoperatively to 29.81 mm 1 month postoperatively and remained around 30.16 mm from 1 year after the surgery.

CONCLUSION

The 3-D printing technique is useful to predict the indentation height and position of the macular buckle. The 3D-printing-assisted macular buckle, in combination with vitrectomy, is an effective, safe and accurate treatment modality for MFS.

FOVEA-SPARING VERSUS COMPLETE INTERNAL LIMITING MEMBRANE PEELING IN VITRECTOMY FOR VITREOMACULAR INTERFACE DISEASES: A Systematic Review and Meta-Analysis

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.

Posterior pole retinotomy for treatment of recurrent macular hole retinal detachment in highly myopic eyes: a pilot study

BACKGROUND

To investigate the feasibility and efficacy of posterior pole retinotomy to treat recurrent macular hole retinal detachment (MHRD) in highly myopic patients.

METHODS

We performed a retrospective study and reviewed the medical records in our hospital between January 1, 2016 and December 31, 2018. Highly myopic patients who received posterior pole retinotomy with silicone oil tamponade for their recurrent MHRD after pars plana vitrectomy were included in the analysis. Postoperative retinal reattachment, best-corrected visual acuity (BCVA), macular hole closure, and complications were evaluated.

RESULTS

There were 11 patients (11 eyes) included in this study. All retinas were reattached. Silicone oil was successfully removed from all eyes 1.5-3 months after the surgery. Macular holes were completely closed in three eyes and remained flat open in eight eyes. The BCVA of all eyes improved significantly at 12 months after surgery (logarithm of the minimal angle of resolution, pre vs. postoperatively, 1.87 ± 0.44 vs. 1.15 ± 0.24, P < 0.05). None of the patients had complications such as endophthalmitis, fundus hemorrhage, retinal redetachment, and proliferative vitreoretinopathy.

CONCLUSION

Posterior pole retinotomy is a safe and effective surgery to treat recurrent MHRD after pars plana vitrectomy in highly myopic patients.

Isolated Central Epiretinal Membrane: A Rare Complication of Fovea-Sparing Internal Limiting Membrane Peeling Technique

Purpose

To report a rare complication presenting as an isolated central epiretinal membrane (ERM) related to fovea-sparing internal limiting membrane (ILM) peeling technique.

Methods

Five patients who received fovea-sparing ILM peeling were enrolled. Postoperatively, an isolated central ERM developed. Optical coherence tomography (OCT) was used to evaluate the serial anatomic change.

Results

Among the five included patients, one patient had high myopia with foveoschisis, two patients had vitreomacular traction, and two patients had proliferative diabetic retinopathy with tractional retinal detachment and a fovea cyst. With an average of 5.80 months, OCT showed the gradual development of the isolated central ERM with severe fovea distortion. Four patients received secondary revision surgery, with improvement of the fovea contour and visual acuity.

Conclusion

The fovea-sparing ILM peeling technique may cause a rare but serious complication as the isolated central ERM, which would cause significant fovea distortion as well as visual deterioration. Timely detection and intervention is recommended to prevent further visual loss. This trial is registered with NCT04445142.

A pilot study on vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis-2y follow-up results

AIM

To evaluate the effect of vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis.

METHODS

Thirty-seven patients with myopic macular retinoschisis who underwent pars plana vitrectomy (PPV) combined with scleral shortening were reviewed. Axial length (AL), the height of macular retinoschisis, the height of retinal detachment if existed, the diameter of macular hole if existed and best corrected visual acuity (BCVA) were obtained. The preoperative and postoperative parameters were compared.

RESULTS

At postoperative 24mo, the mean AL and height of macular retinoschisis were reduced significantly by 0.79 mm and 256.51 µm (t=8.064, P<0.0001; Z=-5.086, P<0.0001) respectively. In addition, the mean height of retinal detachment and diameter of macular hole were also reduced significantly by 365.38 µm and 183.68 µm (Z=-4.457, P=0.000008; Z=-2.983, P=0.003) respectively. Meanwhile, the postoperative BCVA was improved markedly (Z=-2.126, P=0.033).

CONCLUSION

Vitrectomy combined with scleral shortening is an effective surgical method for eyes with myopic macular retinoschisis, whether or not macular hole and retinal detachment are present.