The efficacy of vitrectomy combined with internal limiting membrane peeling to treat high myopia macular hole with macular retinoschisis and it affecting factors_Chinese Journal of Ocular Fundus Diseases

Authors：

Tian Chaowei ,  Wang Yusheng , Zhu Jinting , Li Luxi , Wu Jing

Department of Ophthalmology, The First Affiliated Hospital Ophthalmology, Fourth Military Medical University, Eye Institute of Chinese PLA, Xi'an 710032, China;

Corresponding author：

Wang Yusheng, Email: wangys003@126.com

Keywords：

Retinal perforations/surgery; Retinoschisis/surgery; Myopia, degenerative/complications; Vitrectomy

DOI：

10.3760/cma.j.issn.1005-1015.2017.04.008

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) for macular hole (MH) and macular retinoschisis in high myopic eyes, and to analyze factors affecting the MH closure rate.MethodsThis is a retrospective case study. 21 high myopic patients (22 eyes) with MH and macular retinoschisis were enrolled in this study. All eyes were examined for best corrected visual acuity (BCVA), intraocular pressure, slit lamp microscope, indirect ophthalmoscope, A and/or B-scan ultrasound, optical coherence tomography and visual electrophysiological examination. The BCVA was ranged from finger counting to 0.2. The axial length (AL) was ranged from 26.00 to 31.00 mm, with an average of 27.47 mm. Among 22 eyes, AL was between 26.00 mm to 27.00 mm in 9 eyes, 27.10 mm to 28.00 mm in 5 eyes, 28.10 mm to 29.00 mm in 3 eyes, 29.10 mm to 30.00 mm in 3 eyes, and longer than 30.00 mm in 2 eyes. The diameter of MH was ranged from 227 µm to 597 µm and with an average of 432 µm. Among them, the minimum diameter was between 200 µm to 400 µm in 4 eyes, 401 µm to 450 µm in 13 eyes, 451 µm to 500 µm in 3 eyes, 501 µm to 600 µm in 2 eyes. All the eyes were treated with PPV combined with ILMP surgery. The average follow-up time was 17 months after surgery. The efficacy was determined at the final follow up, including the MH closure, the state of macular retinoschisis and the BCVA. MH closure rate with different MH diameters and different AL were compared and analyzed.ResultsDuring the final follow-up, MH were fully closed in 17 eyes (77.3%), bridge-closed in 4 eyes (18.2%) and not closed in 1 eye (4.5%). Retinoschisis was resolved in 19 eyes (86.4%), partially resolved in 2 eyes (9.1%) and not changed in 1 eye (4.4%). MH with smaller diameter had higher MH closure rate (χ²=12.036, P=0.032). MH with longer AL had lower MH closure rate (χ²=16.095, P=0.003).The final BCVA was ranged from finger counting to 0.25. Among 22 eyes, BCVA or metamorphopsia were improved in 9 eyes (40.9%), stable in 8 eyes (36.4%). BCVA was reduced and metamorphopsia was more severe in 5 eyes (22.7%).ConclusionsPPV combined with ILMP is a safe and effective surgical treatment for MH (with minimum diameter ≤600 μm) and macular retinoschisis in high myopic eyes. After surgery, MH was closed and retinoschisis was resolved in most patients. The major factors affect the MH closure were the minimum diameter of MH and AL.

Citation： Tian Chaowei, Wang Yusheng, Zhu Jinting, Li Luxi, Wu Jing. The efficacy of vitrectomy combined with internal limiting membrane peeling to treat high myopia macular hole with macular retinoschisis and it affecting factors. Chinese Journal of Ocular Fundus Diseases, 2017, 33(4): 359-363. doi: 10.3760/cma.j.issn.1005-1015.2017.04.008 Copy

1.	徐格致, 孙中萃. 关注高度近视黄斑劈裂玻璃体视网膜手术治疗效果的影响因素, 努力提升手术治疗效果[J]. 中华眼底病杂志, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005.2015.04.002.Xu GZ, Sun ZC. Pay attention to the influencing factor of vitrectomy outcome for the treatment of myopic foveoschisis[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005.2015.04.002.
2.	Halfter W, Willem M, Mayer U. Basement membranedependent survival of retinal ganglion cell [J]. Invest Ophthalmol Vis Sci, 2005, 46(3): 1000-1009. DOI: 10.1167/iovs.04-1185.
3.	Laviers H, Zambarakji H. Management of macular hole retinal detachment and macular retinoschisis secondary to pathological myopia: a national survey of UK practice patterns[J]. Eye(Lond), 2013, 27(11): 1324. DOI: 10.1038/eye.2013.177.
4.	Ikuno Y, Tano Y. Vitrectomy for macular holes associated with myopic foveoschisis [J]. Am J Ophthalmol, 2006, 141(4): 774-776. DOI: 10.1016/j.ajo.2005.11.044.
5.	Benhamou N, Massin P, Erginary A, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800.
6.	Kwok A, Lai T. Internal limiting membrane removal in macular hole surgery for severely myopic eyes: a case-control study[J]. Br J Ophthalmol, 2003, 87(7): 885-889.
7.	Hwang JU, Joe SG, Lee JY, et al. Microincision vitrectomy surgery for myopic foveoschisis[J]. Br Ophthalmol, 2013, 97(7): 879-884. DOI: 10.1136/bjophthalmol-2012-302906.
8.	鲁静, 马志中. 玻璃体切割手术联合空气或C₃F₈填充治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.Lu J, Ma ZZ. Clinical outcomes of C₃F₈ and air tamponade after vitrectomy for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.
9.	夏惠娟, 王卫峻, 吴颖, 等. 不同类型近视牵引性黄斑病变玻璃体切割手术后疗效分析[J]. 中华眼底病杂志, 2016, 32(5): 481-485. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.006.Xia HJ, Wang WJ, Wu Y, et al. The efficacy of vitrectomy for myopic traction maculopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 481-485. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.006.
10.	Almony A, Nudelman E, Shah GK, et al. Techniques, rationale, and outcomes of internal limiting membrane peeling [J]. Retina, 2012, 32(5): 877-891. DOI: 10.1097/IAE.0b013e318227ab39.
11.	Tognetto D, Grandin R, Sanguinetti G, et al. Internal limiting membrane removal during macular hole surgery: results of a multicenter retrospective study [J]. Ophthalmology, 2006, 113(8): 1401-1410. DOI: 10.1016/j.ophtha.2006.02.061.
12.	Garcia-Arumi J, Martinez V, Puig J, et al. The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment [J]. Retina, 2001, 21(4): 332-338.
13.	韩治华, 杨淑焕, 王芳, 等. 视网膜劈裂对高度近视黄斑裂孔玻璃体手术的影响[J]. 陕西医学杂志, 2016, 45(2): 217-222. DOI: 10.3969/j.issn.1000-7377.2016.02.037.Han ZH, Yang SH, Wang F, et al. Effect of retinoschisis on vitrectomy for myopic macular hole[J]. Shaanxi Medical Journal, 2016, 45(2): 217-222. DOI: 10.3969/j.issn.1000-7377.2016.02.037.
14.	Nadal J, Verdaguer P, Canut M. Treatment of retinal detachment secondary to macular hole in high myopia[J]. Retina, 2012, 32 (8): 1525-1530. DOI: 10.1097/IAE.0b013e3182411cb8.
15.	邓春梅, 艾明, 江双红, 等. 玻璃体切除联合内界膜剥离术治疗高度近视黄斑裂孔的疗效[J]. 国际眼科杂志, 2015, 15(8): 1398-1401. DOI: 10.3980/j.issn.1672-5123.2015.8.24.Deng CM, Ai M, Jiang SH, et al. Vitrectomy with internal limiting membrane peeling for macular hole in high myopia eyes[J]. Int Eye Sci, 2015, 15(8): 1398-1401. DOI: 10.3980/j.issn.1672-5123.2015.8.24.

1. 徐格致, 孙中萃. 关注高度近视黄斑劈裂玻璃体视网膜手术治疗效果的影响因素, 努力提升手术治疗效果[J]. 中华眼底病杂志, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005.2015.04.002.Xu GZ, Sun ZC. Pay attention to the influencing factor of vitrectomy outcome for the treatment of myopic foveoschisis[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 321-323. DOI: 10.3760/cma.j.issn.1005.2015.04.002.
2. Halfter W, Willem M, Mayer U. Basement membranedependent survival of retinal ganglion cell [J]. Invest Ophthalmol Vis Sci, 2005, 46(3): 1000-1009. DOI: 10.1167/iovs.04-1185.
3. Laviers H, Zambarakji H. Management of macular hole retinal detachment and macular retinoschisis secondary to pathological myopia: a national survey of UK practice patterns[J]. Eye(Lond), 2013, 27(11): 1324. DOI: 10.1038/eye.2013.177.
4. Ikuno Y, Tano Y. Vitrectomy for macular holes associated with myopic foveoschisis [J]. Am J Ophthalmol, 2006, 141(4): 774-776. DOI: 10.1016/j.ajo.2005.11.044.
5. Benhamou N, Massin P, Erginary A, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol, 2002, 133(6): 794-800.
6. Kwok A, Lai T. Internal limiting membrane removal in macular hole surgery for severely myopic eyes: a case-control study[J]. Br J Ophthalmol, 2003, 87(7): 885-889.
7. Hwang JU, Joe SG, Lee JY, et al. Microincision vitrectomy surgery for myopic foveoschisis[J]. Br Ophthalmol, 2013, 97(7): 879-884. DOI: 10.1136/bjophthalmol-2012-302906.
8. 鲁静, 马志中. 玻璃体切割手术联合空气或C₃F₈填充治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.Lu J, Ma ZZ. Clinical outcomes of C₃F₈ and air tamponade after vitrectomy for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.
9. 夏惠娟, 王卫峻, 吴颖, 等. 不同类型近视牵引性黄斑病变玻璃体切割手术后疗效分析[J]. 中华眼底病杂志, 2016, 32(5): 481-485. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.006.Xia HJ, Wang WJ, Wu Y, et al. The efficacy of vitrectomy for myopic traction maculopathy[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 481-485. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.006.
10. Almony A, Nudelman E, Shah GK, et al. Techniques, rationale, and outcomes of internal limiting membrane peeling [J]. Retina, 2012, 32(5): 877-891. DOI: 10.1097/IAE.0b013e318227ab39.
11. Tognetto D, Grandin R, Sanguinetti G, et al. Internal limiting membrane removal during macular hole surgery: results of a multicenter retrospective study [J]. Ophthalmology, 2006, 113(8): 1401-1410. DOI: 10.1016/j.ophtha.2006.02.061.
12. Garcia-Arumi J, Martinez V, Puig J, et al. The role of vitreoretinal surgery in the management of myopic macular hole without retinal detachment [J]. Retina, 2001, 21(4): 332-338.
13. 韩治华, 杨淑焕, 王芳, 等. 视网膜劈裂对高度近视黄斑裂孔玻璃体手术的影响[J]. 陕西医学杂志, 2016, 45(2): 217-222. DOI: 10.3969/j.issn.1000-7377.2016.02.037.Han ZH, Yang SH, Wang F, et al. Effect of retinoschisis on vitrectomy for myopic macular hole[J]. Shaanxi Medical Journal, 2016, 45(2): 217-222. DOI: 10.3969/j.issn.1000-7377.2016.02.037.
14. Nadal J, Verdaguer P, Canut M. Treatment of retinal detachment secondary to macular hole in high myopia[J]. Retina, 2012, 32 (8): 1525-1530. DOI: 10.1097/IAE.0b013e3182411cb8.
15. 邓春梅, 艾明, 江双红, 等. 玻璃体切除联合内界膜剥离术治疗高度近视黄斑裂孔的疗效[J]. 国际眼科杂志, 2015, 15(8): 1398-1401. DOI: 10.3980/j.issn.1672-5123.2015.8.24.Deng CM, Ai M, Jiang SH, et al. Vitrectomy with internal limiting membrane peeling for macular hole in high myopia eyes[J]. Int Eye Sci, 2015, 15(8): 1398-1401. DOI: 10.3980/j.issn.1672-5123.2015.8.24.

Chinese Journal of Ocular Fundus Diseases

The efficacy of vitrectomy combined with internal limiting membrane peeling to treat high myopia macular hole with macular retinoschisis and it affecting factors

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content