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

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.

Fovea-sparing internal limiting membrane peeling with inverted flap technique versus standard internal limiting membrane peeling for symptomatic myopic foveoschisis

“…Zheng et al, who compared fovea sparing ILM surgery with and without the inverted flap, reported two cases of postoperative MH, one for each type of surgery. However, the MH in the non-inverted flap group required further surgery, whereas the inverted flap MH spontaneously closed at four months, presumably due to the presence of the flap 15 . More recently, Feng et al compared standard and fovea-sparing ILM peeling with combined FSIF ILM peeling in eyes with MF and lamellar hole and found a lower risk of post-operative MH.…”

“…Despite the growing consensus favoring fovea-sparing ILM peeling, recent reports have hinted at the potential for further refinement. Some authors have suggested that, particularly in cases with very thin fovea, such as outer lamellar holes with foveal detachment, the limited mechanical force applied during fovea sparing could still damage the extremely fragile tissue 15 , 18 . As a response to this concern, the combination with the inverted flap technique, well-established for treating large or persistent idiopathic MH or myopic MH, has been proposed 14 , 15 , 19 , 20 .…”

Comparison of three ILM peeling techniques for myopic traction maculopathy with high risk of postoperative macular hole development

“… 23 , 24 Yet, a recent study evaluated the FSIP with or without ILMF technique for myopic foveoschisis and found the occurrence of postoperative FTMH was similar. 25 One possible explanation is the different subjects. The proportion of LMH (100%) and FD (73%) in our study is much higher than that (70% and 34%) in the recent study, which may cause the difference.…”

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

“…Given our interpretation of Fig. 3 and the small case number in the study by Zheng et al, [ 1 ] we think the conclusion made by them may require some modifications.…”

“…We read with interest the article “Anatomical and visual outcomes of fovea‑sparing internal limiting membrane (ILM) peeling with or without inverted flap technique for myopic foveoschisis” by Zheng et al [ 1 ]. In this article, the authors compared two different surgical techniques for treating myopic foveoschisis, and found that fovea‑sparing ILM peeling, either with or without inverted flap, resulted in similar anatomical and visual outcomes.…”