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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.
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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
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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.
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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
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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.
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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
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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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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.
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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.
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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
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Xin WJ, Jiang JZ, Ji LB, Lv WJ, Gu YX, Xiao Y. Efficiency comparison with fovea-sparing internal limiting membrane peeling and complete internal limiting membrane peeling for treating myopic traction maculopathy. Graefes Arch Clin Exp Ophthalmol 2021; 260:73-81. [PMID: 34309768 DOI: 10.1007/s00417-021-05320-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To explore whether the efficacy of fovea-sparing internal limiting membrane peeling (FS-ILMP) is better than that of complete internal limiting membrane peeling (ILMP). METHODS This retrospective clinical study included 34 cases (34 eyes) with myopic traction maculopathy collected from June 2017 to February 2019. Twenty-three-gauge (23-G) pars plana vitrectomy (23G PPV) was performed on all patients. In the FS-ILMP group, 18 eyes retained the internal limiting membrane (ILM) of about 1 to 1.5 papillary diameter centered on fovea centralis, while in the standard ILMP group, the ILM was completely removed from 16 eyes. The best corrected visual acuity (BCVA), central foveal thickness (CFT), and other indexes were collected before and 6 months after surgery. RESULTS There was no significant difference in baseline clinical characteristics between the two groups. CFT and BCVA were significantly improved in both FS-ILMP and standard ILMP group, but the postoperative BCVA of the FS-ILMP group was significantly better than that of the standard ILMP group (P < 0.001). Two cases of subretinal effusion in macula were recorded in the FS-ILMP group, and three eyes in the standard ILMP group developed macular holes after surgery. Although both treatments relieved the mechanical traction of macular fovea, the patients in the FS-ILMP group showed better clinical outcomes in various aspects. CONCLUSION These results improved our understanding of the clinical application of vitrectomy combined with preservation of ILM upon the fovea centralis, which might lay a foundation for in-depth study on the treatment of myopic traction maculopathy.
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Affiliation(s)
- Wen-Jian Xin
- Department of Ophthalmology, Military Ophthalmological Center, General Hospital of Xinjiang Military Region, No. 754 Beijing Middle Road, Urumqi, 830054, Xinjiang, China
| | - Ji-Ze Jiang
- Department of Ophthalmology, Military Ophthalmological Center, General Hospital of Xinjiang Military Region, No. 754 Beijing Middle Road, Urumqi, 830054, Xinjiang, China
| | - Lei-Bing Ji
- Department of Ophthalmology, Military Ophthalmological Center, General Hospital of Xinjiang Military Region, No. 754 Beijing Middle Road, Urumqi, 830054, Xinjiang, China
| | - Wen-Juan Lv
- Department of Ophthalmology, Military Ophthalmological Center, General Hospital of Xinjiang Military Region, No. 754 Beijing Middle Road, Urumqi, 830054, Xinjiang, China
| | - Yong-Xin Gu
- Department of Ophthalmology, Military Ophthalmological Center, General Hospital of Xinjiang Military Region, No. 754 Beijing Middle Road, Urumqi, 830054, Xinjiang, China
| | - Yun Xiao
- Department of Ophthalmology, Military Ophthalmological Center, General Hospital of Xinjiang Military Region, No. 754 Beijing Middle Road, Urumqi, 830054, Xinjiang, China.
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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.
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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
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Yao Y, Qu J, Shi X, Hu J, Hou J, Miao H, Cheng Y, Zhao M. Vitrectomy With Silicone Oil Tamponade and Without Internal Limiting Membrane Peeling for the Treatment of Myopic Foveoschisis With High Risk of Macular Hole Development. Front Med (Lausanne) 2021; 8:648540. [PMID: 34124090 PMCID: PMC8193352 DOI: 10.3389/fmed.2021.648540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/06/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose: To explore the efficiency and safety of the surgical procedure of pars plana vitrectomy (PPV) with silicone oil (SO) tamponade and without internal limiting membrane (ILM) peeling for myopic foveoschisis (MF) eyes with high risk of macular hole formation. Methods: Three eyes (three patients) with MF and foveal detachment were enrolled into the study. Comprehensive preoperative ophthalmological assessments, including best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were performed on the eyes. Central foveal thickness (CFT) and thickness of continuous neurosensory retina at foveola were measured. All patients underwent PPV followed by SO tamponade and without ILM peeling. SO was removed when MF and retinal detachment were resolved. Patients were followed up postoperative at month 1, 3, 6, and 12. Results: All the three eyes achieved complete resolution of MF and foveal reattachment with an average SO tamponade period of 11.67 ± 0.58 months. The average CFT at 6 months was 91 ± 27.5 μm, hence reduced significantly from baseline at 365.3 ± 137.85 μm (P = 0.037). There was no postoperative macular hole formation despite the average preoperative sensory retina thickness of 58 ± 20.07 μm. Mean BCVA was improved from logMAR 1.43 ± 0.75 to logMAR 0.8 ± 0.75 on the last follow-up. Manageable SO-related complications were reported, including SO emulsification, ocular hypertension, and cataract. Conclusion: Vitrectomy with SO tamponade and without ILM peeling as an optional surgical protocol to treat MF is effective and safe, especially for MF eyes vulnerable to macular hole formation.
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Affiliation(s)
- Yuou Yao
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Jinfeng Qu
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xuan Shi
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Jie Hu
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Jing Hou
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Heng Miao
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yong Cheng
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Mingwei Zhao
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, College of Optometry, Peking University Health Science Center, Beijing, China
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10
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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.
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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
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11
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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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12
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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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