Vitrectomy with or without internal limiting membrane peeling for myopic foveoschisis

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.

Efficacy of pars plana vitrectomy combined with internal limiting membrane peeling and gas tamponade for treating myopic foveoschisis: a meta-analysis

“…A total of 645 articles were identified through database searching. After excluding 98 duplicates and 223 studies such as systematic reviews and case reports, 10 articles [ 9 – 18 ] were ultimately included for meta-analysis based on the inclusion and exclusion criteria and after full-text assessment for studies with unclear diagnostic criteria and non-conforming interventions. The literature selection flowchart is shown in Fig.…”

Case report: Outer lamellar macular hole and outer retinal detachment within myopic foveoschisis post-cataract surgery

“…Many vitreoretinal surgery modalities have been reported, and a combination of pars plana vitrectomy, internal limiting membrane peeling, with or without macular buckle, is generally believed to achieve a good visual outcome by eliminating both tangential and anterior–posterior tractions ( 12 ). Vitrectomy alone without inner limiting membrane peeling, but with careful removal of the posterior hyaloid, has also been shown to produce a comparable outcome compared with vitrectomy with inner limiting membrane peeling ( 13 ). Zhao et al ( 14 ) demonstrated favorable long-term results of macular buckling for highly myopic eyes with both myopic foveoschisis and macular holes.…”

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy

“…In our study, after PSR followed by vitrectomy, OCT showed that 95.45% of MF eyes achieved complete resolution of the MF, and the remaining 4.55% of MF eyes achieved partial resolution. While only 61.0%-80.0% of eyes achieved total resolution of foveoschisis after PPV alone [17,[20][21] , and only 83.33% of eyes achieved complete resolution of foveoschisis after PSR alone [18] . Our current study showed that PSR followed by vitrectomy got better BCVA improvement and MF resolution than that of PSR or vitrectomy alone.…”