Posterior scleral reinforcement combined with vitrectomy for myopic foveoschisis

The effectiveness and safety of posterior scleral reinforcement with vitrectomy for myopic foveoschisis treatment: a systematic review and meta-analysis

PURPOSE

To investigate the effectiveness and safety of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis (MF) treatment.

METHODS

We conducted a systematic review and meta-analysis. We evaluated the improvement of best-corrected visual acuity (BCVA) in logMAR unit, the percentage of patients with improved or stabled BCVA, benefit on axial length (AL), the retinal reattachment rate, the macular hole (MH) closure rate, as well as the complication rate.

RESULTS

Fourteen studies (311 eyes) were included. Overall, patients' BCVA improved - 0.46 (95% confidence interval [CI] - 0.52, - 0.40) logMAR unit, with 80% (95%CI 74%, 85%) benefiting from BCVA improvement and 6% (95%CI 3%, 10%) suffering from BCVA loss. Patients' AL was shortened by - 1.74 (95%CI - 2.92, - 0.57) mm, and for patients whose AL was ≥ 30 mm, the average benefit reached - 3.68 (95%CI - 4.59, - 2.77) mm. Ninety-three percent (95%CI 89%, 96%) of the patients achieved retinal reattachment, and 65% (95%CI 47%, 80%) of the MH was closed. Patients' central foveal thickness decreased; the MD was - 187.32 (95%CI - 206.25, - 168.40) mm. The pooled complication rate was 9% (95%CI 8%, 19%), with extrusion, choroidal atrophy, and choroidal neovascularization being the most common complications. Subgroup analysis indicated no statistical difference in BCVA improvement, AL change, retinal reattachment rate, and complication rate between patients with or without MH. Subgroup analysis indicated no statistical difference in the above four outcomes between the primary and the recurrent patients either. There was no statistical difference in the above four outcomes no matter ILM peeling was combined or not.

CONCLUSION

PSR combined with vitrectomy helps improve 80% MF patients' BCVA; the average benefit on BCVA is - 0.46 logMAR unit. The average change in AL is - 1.74 mm; patients with AL ≥ 30 mm benefit much more than the patients with AL < 30 mm. The retinal reattachment rate is up to 93%; the MH closure rate is 65%. About 9% patients will suffer from extrusion, choroidal atrophy, choroidal neovascularization, and other complications. The outcomes were not influenced by presence of MH, disease recurrence, or ILM peeling.

Surgical outcome and prognostic factors influencing visual acuity in myopic foveoschisis patients

BACKGROUND

To analyze the optical coherence tomography (OCT) characteristics and visual outcome of vitrectomy in myopic foveoschisis (MF) patients and identify prognostic factors.

METHODS

This study is a retrospective clinical cohort study in tertiary care hospital. Thirty-two eyes of 32 patients who underwent MF-related vitrectomy in were investigated retrospectively. Best-corrected visual acuity (BCVA) measured at 1 year post surgery and changes in central foveal thickness (CFT) and co-existing macular pathologies, such as foveal detachment (FD), lamellar holes, and macular holes were the main outcome measures. Prognostic factors were identified using multivariate linear regression analysis.

RESULTS

Average BCVA (in logarithm of the minimum angle of resolution) and mean CFT had improved from 0.46 ± 0.06 to 0.37 ± 0.07 (P = 0.089) and from 485.72 ± 164.69 to 341.71 ± 109.70 (P < 0.001), respectively. Univariate analysis identified baseline BCVA, epiretinal membrane, no coexisting OCT features other than MF, FD on OCT, and gas injection as significantly associated with visual outcome (P < 0.001, 0.014, 0.022, < 0.001, and 0.030). Better baseline BCVA and absence of FD on OCT remained significant (P < 0.001 and < 0.001, respectively) after multivariate analysis.

CONCLUSION

Good preoperative visual acuity and absence of FD pre-surgery are important predictors of good visual prognosis. Thus, timely surgical intervention, before development of macular complications, may improve visual outcome after surgical treatment of patients with MF.

A Review of Current Myopic Foveoschisis Management Strategies

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.

Macular buckle technique in myopic traction maculopathy: a 16-year review of the literature and a comparison with vitreous surgery

PURPOSE

The aim of this study is to review anatomical and functional outcomes following macular buckling (MB) in high myopia and to compare such results with those obtained by pars plana vitrectomy (PPV).

METHODS

PubMed articles on MB in high myopia (2000-2016) were reviewed. Main outcomes included retinal reattachment and macular hole (MH) closure rates, resolution of myopic foveoschisis (MFS), and postoperative visual acuity.

RESULTS

Thirty-one articles included 16 in patients with retinal detachment due to MH (MHRD group), 11 in MFS with or without foveal detachment (MFS group), and 4 in MH patients with MFS (MH-MFS group). Surgical techniques mainly differed in the type of buckle, rectus muscles involvement, and concurrent PPV. In eyes with persistent MH, prognosis in the MHRD and MH-MFS groups differed between eyes receiving MB compared to PPV: functional outcome was markedly poorer and there was a higher risk of retinal redetachment associated with PPV. In the MSF group, secondary MHs were more likely to develop in eyes treated with PPV and internal limiting membrane peeling than those undergoing MB alone or combined with PPV. Retinal pigment epithelium changes, malpositioning, perforation, and choroidal detachment were the main complications.

CONCLUSIONS

Although different approaches are used, complete resolution of foveoschisis, retinal reattachment, and MH closure seem to be achieved more frequently with MB than PPV.