Vitrectomy with Fovea-Sparing Internal Limiting Membrane Peeling for Myopic Foveoschisis

Abstract

Myopic foveoschisis is a rare form of a tractional maculopathy, which occurs in patients with elevated axial length. The contraction of the posterior hyaloid exerts tangential traction on the retinal surface with a subsequent continuous splitting of the retinal layers. Internal limiting membrane (ILM) peeling has been advocated in foveoschisis, but it has been associated with post-operative macular hole formation. We report on a modified surgical technique, which spares the fovea and may reduce the risk for macular hole formation. Retrospective analysis of 6 patients with myopic foveoschisis. The mean age was 53.8 ± 12.9 years (4M, 2F) and mean myopia was - 18.3 ± 6.5 Dpt. After a 23 g pars plana vitrectomy, the ILM was peeled on the entire macular surface, except in the foveal region lest the thin foveal structures be damaged. All patients received a gas tamponnade with 23 % SF6 and maintained a face down position for 5 days. Mean best-corrected pre-operative visual acuity was 0.87 ± 0.56 logMAR, which increased to 0.60 ± 0.40 logMAR at the end of follow-up. The retinal thickness, as measured by optical coherence tomography, decreased from 799 ± 352 micrometers to 318 ± 60 micrometers at the end of follow-up 7.8 ± 5.7 months. No case developed a macular hole. Vitrectomy with fovea sparing ILM peeling is a promising surgical technique, which results in an improved foveal anatomy and retinal function. Due to the sparing of the fovea, this surgical technique may reduce the risk of macular hole formation in the post-operative period.

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

“…This patient had been diagnosed with epiretinal membrane, but he did not undergo ILM peeling during PPV. Many studies have reported the usefulness of ILM peeling [15,24]. It has also been reported that fovea-sparing ILM peeling can be an effective approach for treating MF without risk of MH [24].…”

“…Many studies have reported the usefulness of ILM peeling [15,24]. It has also been reported that fovea-sparing ILM peeling can be an effective approach for treating MF without risk of MH [24]. Huang et al [25] found that the prevalence of secondary MH RD after PPV without ILM peeling is high in patients with preoperative FD.…”

Fovea-Sparing Versus Complete Internal Limiting Membrane Peeling in Vitrectomy for Vitreomacular Interface Diseases

“… 35 As a result of this procedure, traction forces change their direction from centrifugal to centripetal, and the integrity of the end feet of the foveal Müller cells and macular structure is preserved. 13 , 36 …”

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

“…2020). Additionally, many have proven that the rate of occurrence for secondary MH significantly decreased after PPV combined with fovea‐sparing ILM peeling (Seppey & Wolfensberger 2017). However, the traction caused by vascular stiffness and posterior staphyloma can only be resolved by MB in MFS eyes, particularly in cases of a thin foveal roof, outer lamellar holes and severe foveal detachment on OCT (Alkabes & Mateo 2018).…”