Relationship between macular bending and foveoschisis in myopic patients

Novel surgical approaches for treating myopic traction maculopathy: a meta-analysis

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.

RELATIONSHIP BETWEEN INTEGRITY OF HENLE FIBERS AND VISUAL ACUITY IN MYOPIC FOVEOSCHISIS

BACKGROUND

To analyze the relationship between Henle fiber (HF) integrity and visual acuity in highly myopic eyes with foveoschisis.

METHODS

Three hundred and fifty-eight highly myopic eyes were included in this study and divided into three groups according to the Triton optical coherence tomography results. Group 1 included 19 eyes with myopic foveoschisis where the inner and outer retina were connected by a columnar structure in the HF layer at the foveolar area. Group 2 included 17 eyes with myopic foveoschisis where the columnar structure was disrupted in the HF layer at the foveolar area. Group 3 included 322 eyes without myopic foveoschisis or other ocular disease. Clinical and optical coherence tomography findings were obtained and compared.

RESULTS

Eyes with vitreomacular traction, arteriolar traction, and longer axial length were more likely to have myopic foveoschisis with intact columnar structure in the HF layer (odds ratio [OR], 12.84; P = 0.001; OR, 7.63; P = 0.04; OR, 2.03; P = 0.03) and with disrupted columnar structure in the HF layer (OR, 65.21; P = 0.001; OR, 6.60; P = 0.02; OR, 2.63; P = 0.01). Moreover, eyes with disrupted columnar structure in the HF layer presented a lower best-corrected visual acuity (P = 0.001), longer axial length (P = 0.001; P = 0.009), higher central foveolar thickness (P = 0.001; P = 0.02), and a higher prevalence of vitreomacular traction (P = 0.001; P = 0.04) than control or integrity HF eyes. Furthermore, worse best-corrected visual acuity was related to myopic foveoschisis with disrupted columnar structure in the HF layer (P < 0.01).

CONCLUSION

The integrity of HF in patients with myopic foveoschisis appears to play an important role in visual acuity.

Tilted disc syndrome (TDS): New hypotheses for posterior segment complications and their implications in other retinal diseases

Tilted disc syndrome (TDS) is considered a congenital anomaly due to a delayed closure of the embryonic fissure. It is characterized by an oblique orientation of the axis of the optic disc, associated with other posterior pole anomalies such as inferior crescent, situs inversus and inferior staphyloma. The aim of this review was to summarize the data supporting the current hypotheses for the pathogenesis of TDS, and its anatomical and functional clinical consequences. Recent imaging techniques, such as magnetic resonance imaging, wide-field fundus imaging, and 2- and 3-D optical coherence tomography have provided a new perspective on TDS and its complications. Different abnormalities have previously been reported, both in the anterior and posterior segments. The focus was on vision-threatening chorioretinal changes or complications, including choroidal neovascularization and serous retinal detachments and their therapeutic options. Based on clinical observations, assumptions were proposed to understand the occurrence of complications such as chorioretinal degenerative changes, choroidal neovascularization and polypoidal choroidal vasculopathy, macular serous retinal detachment, myopic foveoschisis and chorioretinal folds. These hypotheses could be referred to as the curvature "breaking point" hypothesis, the uneven growth "tractional" hypothesis, the "container-content" imbalance hypothesis, and the "choroidal funnel" hypothesis. Because these complications could also occur in other contexts, understanding the pathogenesis of TDS complications could help to understand their pathophysiology.

Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study

The aim of the present study was to investigate whether internal limiting membrane (ILM) peeling in patients with myopic foveoschisis (MF) treated with 23-gauge (23G) vitrectomy improved the anatomical and visual outcomes. In this retrospective cohort study, from March 2014 to August 2017 at the Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University (Nanchang, China), 60 patients (60 eyes) with MF underwent 23G vitrectomy. The patients were grouped according to whether they underwent brilliant blue-assisted ILM peeling (peeling group) or not (non-peeling group). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were measured. There were 30 eyes in each group and the baseline characteristics were similar (all P>0.05). BCVA improved in 24 eyes (80%) in the peeling group and 25 eyes (83.3%) in the non-peeling group (P=0.922). Preoperative CMT was not significantly different between the peeling and non-peeling group (458±62.2 vs. 460±61.1 µm, respectively, P=0.229). However, postoperative CMT was significantly different between the peeling and non-peeling group (269.3±67.7 vs. 294.4±60.5 µm, respectively; P=0.015). In the peeling group, MF was completely resolved in all 30 eyes, but only in 26 eyes in the non-peeling group (P=0.038). Postoperative Amsler testing was positive in five eyes in the peeling group and 13 eyes in the non-peeling group (P=0.024). Complications were similar in both groups; postoperatively, there were one and two cases of iatrogenic peripheral retinal break, three and two cases of macular hole, and one and one case of retinal detachment in the peeling and non-peeling groups, respectively.23G vitrectomy combined with brilliant blue-assisted ILM peeling resulted in better visual and anatomical effects compared with 23G vitrectomy alone in patients with MF.

Observational study of clinical characteristics of dome-shaped macula in Chinese Han with high myopia at Zhongshan Ophthalmic Centre

PURPOSE

To evaluate the prevalence of dome-shaped macula (DSM) in highly myopic eyes among Chinese Han and to detect the correlation with myopic maculopathy and macular complications.

METHODS

A total of 736 Chinese Han patients (1384 eyes) with high myopia (refractive error≤6.0 diopters or axial length ≥26.5 mm) are reviewed based on information entered into a high-myopia database at Zhongshan Ophthalmic Centre. Subfoveal choroidal thickness (SFCT) and parafoveal choroidal thickness (PFCT) are measured. The prevalence of DSM in patients with myopic maculopathy is categorised from C0 to C4. Clinical features, including macular complications, SFCT and PFCT, are compared between myopic eyes with and without DSM.

RESULTS

Among the 1384 eyes, 149 (10.77%) show DSM. In highly myopic eyes without macular complications, the best corrected visual acuity is significantly worse in patients with DSM (p=0.002), and the ratio between subfoveal and parafoveal choroidal thickness (S/PCT) is significantly elevated in patients with DSM (p=0.021). The proportion of foveal schisis (17.24% vs 62.86%) is much lower in eyes with DSM compared with those without DSM. However, the proportions of extrafoveal schisis (39.66% vs 5.37%), foveal serous retinal detachment (SRD) (5.17% vs 0) and epiretinal membrane (ERM) (24.14% vs 10.74%) are much higher in eyes with DSM. The proportion of DSM was lower in C0 and C1, but higher proportion of DSM was found in C3 and C4.

CONCLUSIONS

DSM is found in 10.77% of highly myopic eyes among Chinese Han. DSM might be a protective mechanism for foveal schisis and a risk factor for extrafoveal schisis, SRD and ERM.

Comparison of long-term clinical evolution in highly myopic eyes with vertical oval-shaped dome with or without untreated serous retinal detachment

Background

To compare the long-term clinical evolution of highly myopic eyes with vertical oval-shaped dome associated with or without untreated serous retinal detachment.

Methods

Twenty-eight patients with high myopia (40 eyes) with smooth macular elevations related to a vertical oval-shaped dome were recruited. Serous retinal detachment was investigated; 11 eyes had persistent submacular fluid (study group) and 29 eyes lacked submacular fluid (control group). All patients underwent complete ophthalmological examinations, including optical coherence tomography at baseline every 6 months for 2 years. Fluorescein angiographies were performed in cases with serous retinal detachment to rule out choroidal neovascularisation.

Results

There were no statistical differences in baseline age, sex, spherical equivalence or axial length between the two groups. Serous retinal detachment always occurred at the top of the inward macular incurvation. Moreover, no statistically significant differences in mean best-corrected visual acuity were observed during the 24-month follow-up period in the study and control groups and between the two groups at all time points. The mean central foveal thickness was significantly higher in the study group at each visit (p=0.001, in all cases). At the final follow-up visit, complete resolution of the serous retinal detachment was achieved in 1 of the 11 study group’s eyes.

Conclusions

Serous retinal detachment is a complication associated with vertical oval-shaped domes that seems to remain stable in terms of visual function over time without treatment.

VISUAL ACUITY OUTCOMES OF RANIBIZUMAB TREATMENT IN PATHOLOGIC MYOPIC EYES WITH MACULAR RETINOSCHISIS AND CHOROIDAL NEOVASCULARIZATION

Myopic macular retinoschisis (MRS) is a progressive, degenerative alteration in pathologic myopia and may be found in conjunction with myopic choroidal neovascularization. Frequent and continuous ranibizumab treatment effectively control myopic choroidal neovascularization in eyes with MRS and lead to satisfying treatment results.

Purpose:

To investigate visual and morphological outcome in eyes with MRS and choroidal neovascularization (CNV) secondary to pathologic myopia treated with intravitreal (IVT) ranibizumab.

Methods:

Post hoc analysis of the patients included in the RADIANCE trial (n = 277) was performed to evaluate the impact of MRS on the functional outcome in patients with myopic choroidal neovascularization (mCNV) undergoing intravitreal ranibizumab injections.

Results:

Prevalence of MRS in pathologic myopia population is 6%. Respective patients were generally older than patients without MRS. Study eyes with MRS at baseline (BL) showed an initially poor treatment response after 3 months (mean change in best corrected visual acuity (BCVA) was 2.8 ± 12.4 letters, P = 0.009). After 12 months of treatment however, the mean change in BCVA was 7.1 ± 14.5 early treatment diabetic retinopathy study (ETDRS) letters (P = 0.025). Patients with MRS at baseline received more intravitreal injections than the other RADIANCE patients without MRS (MRS, n = 15 eyes: 5.8 ± 2.1 vs. RADIANCE non-MRS [n = 207 eyes]: 4.0 ± 2.9; P = 0.0001).

Conclusion:

Improvement of visual acuity is delayed and reduced after 3 months intravitreal ranibizumab in eyes with MRS and myopic choroidal neovascularization compared to eyes without MRS. More ranibizumab injections are needed in eyes with MRS to gain comparable BCVA at Month 12.

Two- and three-dimensional topographic analysis of pathologically myopic eyes with dome-shaped macula and inferior staphyloma by spectral domain optical coherence tomography

PURPOSE

To investigate the posterior anatomical structure of pathologically myopic eyes with dome-shaped macula and inferior staphyloma using spectral domain optical coherence tomography (SD-OCT).

METHODS

Our database of 260 pathologically myopic eyes was analyzed retrospectively to identify patients with dome-shaped macula and inferior staphyloma. All patients underwent vertical and horizontal SD-OCT scans across the central fovea, with three-dimensional macular map reconstruction. Best-corrected visual acuity, axial length, and choroidal thickness measurements were recorded. The macular bulge height was also analyzed in eyes with dome-shaped macula. In the three-dimensional images, the symmetry and orientation of the main plane of the inward incurvation of the macula were examined.

RESULTS

Twenty-eight (10.7%) of the 260 pathologically myopic eyes had dome-shaped macula of one of three different types: a round radially symmetrical dome (eight eyes, 28.5%), a horizontal axially symmetrical oval-shaped dome (15 eyes, 53.5%), or a vertical axially symmetrical oval-shaped dome (five eyes, 17.8%). The macular bulge height was significantly greater in horizontal oval-shaped dome eyes (p = 0.01, for each comparison). Inferior posterior staphylomas were observed in ten (3.8%) of the 260 pathologically myopic eyes with asymmetrical macular bends.

CONCLUSIONS

Vertical and horizontal OCT sectional scanning in combination with three-dimensional macular map reconstruction provides important information for understanding the posterior anatomical structure of dome-shaped macula and inferior staphyloma in pathologically myopic eyes.

Chorioretinal atrophy after spontaneous resolution of myopic foveoschisis

Myopic foveoschisis is one of the major complications of pathologic myopia, and it was most recently identified by new imaging modalities. During the natural evolution of this complication, anatomical and visual improvement without surgical intervention is an unusual course, and most of these eyes remain stable or progressively worsen. The authors report a case of a highly myopic eye that developed patchy chorioretinal atrophy after spontaneous resolution of myopic foveoschisis, which to the best of our knowledge has not been reported previously in the medical literature.