Clinical observation of vitrectomy combined with internal limiting membrane peeling and scleral shortening for myopic foveoschisis_Chinese Journal of Ocular Fundus Diseases

Authors：

Xiao Yawei , Hao Yuhua , Shang Qingli , Yin Zhibo , Yang Yaqing ,  Ye Cunxi

Department of Ophthalmology, The Second Affiliated Hospital, Hebei Medical University, Shijiazhuang 050000, China;

Corresponding author：

Ye Cunxi, Email: yecunxi@163.com

Keywords：

Myopia, degenerative/complications; Myopia, degenerative/surgery; Retinal perforations/surgery; Vitreoretinal surgery; Scleroplasty

DOI：

10.3760/cma.j.issn.1005-1015.2017.04.011

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ObjectiveTo observe the efficacy of vitrectomy combined with internal limiting membrane (ILM) peeling and scleral shortening for myopic foveoschisis (MF).MethodsProspective and non-randomized concurrent control study. A total of 35 MF patients (35 eyes) were enrolled in this study. The patients were divided into 2 groups according to surgery, including group A (18 eyes) and group B (17 eyes), all received vitrectomy combined with ILM peeling, but group A also received scleral shortening. The best corrective visual acuity (BCVA) examination using the Snellen vision chart was converted to the minimum resolution logarithm (logMAR). Ocular axis length (AL) was measured by Zeiss IOL-Master or A-scan ultrasound (Quantel Medical, France). The maximal value of retinal foveoschisis (MxFT) was measured by frequency-domain optical coherence tomography (Heidelberg, Germany). Multifocal electroretinogram (mfERG) responses were obtained with the RETIscan system (Roland Consult, Gemany).There was no statistically significant difference between the two groups (P＞0.05) in age (t=0.460), AL (t=1.520), diopter (t=0.020), logMAR BCVA (t=−2.280), MxFT (Z=−4.179) and b-wave ERG amplitude (Z=−0.198). The changes of BCVA, AL, MxFT and b wave amplitude were followed-up for 3-12 months.ResultsAt the last follow-up, the height of MF was decreased in 18 eyes of group A, and MF was completely disappeared in 4 eyes. The logMAR BCVA (t=7.272, 5.951), MxFT (Z=−3.724, −3.622) and b- wave ERG amplitude (Z=−3.223, −3.243) in both groups A and B were statistically improved (P=0.000, 0.000, 0.000, 0.000, 0.001, 0.001) compared to pre-operational results. There was significant difference of logMAR BCVA (t=−2.280) and MxFT (Z=−4.179) between the two groups (P=0.029, 0.000). But there was no significant difference in the amplitude of b-wave（Z=−0.198, P=0.843). The AL in group A was shortened after surgery, the difference was statistically significant (t=10.017, P=0.000). During the follow-up, there was no ocular hemorrhage, endophthalmitis and other complications.ConclusionPPV combined with ILM peeling and scleral shortening can shorten AL significantly for MF patients, and gain relative normal anatomical structure of the fovea, thus improve the vision.

Citation： Xiao Yawei, Hao Yuhua, Shang Qingli, Yin Zhibo, Yang Yaqing, Ye Cunxi. Clinical observation of vitrectomy combined with internal limiting membrane peeling and scleral shortening for myopic foveoschisis. Chinese Journal of Ocular Fundus Diseases, 2017, 33(4): 373-377. doi: 10.3760/cma.j.issn.1005-1015.2017.04.011 Copy

1.	Wu PC, Chen YJ, Chen YH, et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond), 2009, 23(2): 356-361. DOI: 10.1038/sj.eye.6703038.
2.	Qi Y, Duan AL, You QS, et al. Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia[J]. Retina, 2015, 35(2): 351-357. DOI: 10.1097/IAE.0000000000000313.
3.	Lim SJ, Kwon YH, Kim SH, et al. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis[J]. Graefe’s Arch Clin Exp Ophthalmol, 2012, 250(11): 1573-1577. DOI: 10.1007/s00417-012-1983-y.
4.	Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography[J]. Science, 1991, 254(5035): 1178-1181.
5.	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.1005-1015.2015.04.002.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.1005-1015.2015.04.002.
6.	李楚, 郑文斌, 黄浩, 等.高度近视黄斑劈裂治疗研究进展[J]. 中华眼底病杂志, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.Li C, Zheng WB,Huang H,et al.Progress in the treatment of myopic foveoschisis[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.
7.	Bando H, Ikuno Y, Choi JS, et al. Ultrastructure of internal limiting membrane in myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(1): 197-199.
8.	Taniuchi S, Hirakata A, Itoh Y, et al. Vitrectomy with or without internal limiting membrane peeling of reach stage of myopic traction maculopathy[J]. Retina, 2013, 33(10): 2018-2025.DOI:10.1097/IAE.0b013e3182a4892b.
9.	马进, 朱铁培, 张倩茹, 等. 高度近视黄斑劈裂视网膜内界膜剥离手术联合全氟丙烷眼内填充疗效评价[J]. 中华眼底病杂志, 2009, 25(5): 341-343. DOI: 10.3670/cma.j.issn.1005-1015.2009.05.05.Ma J, Zhu TP, Zhang QR, et al. Internal limiting membrane peeling and perfluoropropane tamponade for macular retinoschisis with high myopia[J]. Chin J Ocul Fundus Dis, 2009, 25(5): 341-343. DOI: 10.3670/cma.j.issn.1005-1015.2009.05.05.
10.	Takano M, Kishi S.Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476.
11.	张娅萍, 毛广运, 王毓琴, 等.后巩膜加固手术治疗病理性近视黄斑劈裂的疗效观察[J]. 中华眼底病杂志, 2015, 31(4): 324-328. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.003.Zhang YP, Mao GY, Wang YQ, et al. The efficacy of posterior scleral reinforcement for macular retinoschisis in pathological myopia[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 324-328. DOI: 10.3670/cma.j.issn.1005-1015.2015.04.003.
12.	Baba T, Tanaka S, Maesawa A, et al. Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole[J]. Am J Ophthalmol, 2006, 142(3): 483-487.
13.	Zhu Z, Ji X, Zhang J, et al. Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J]. Clin Exp Ophthalmol, 2009, 37(7): 660-663. DOI: 10.1111/j.1442-9071.2009.02111.x.
14.	Nakagawa N, Parel JM, Murray TG, et al. Effect of scleral shortening on axial length[J]. Arch Ophthalmol, 2000, 118(7): 965-968.

1. Wu PC, Chen YJ, Chen YH, et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia[J]. Eye (Lond), 2009, 23(2): 356-361. DOI: 10.1038/sj.eye.6703038.
2. Qi Y, Duan AL, You QS, et al. Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia[J]. Retina, 2015, 35(2): 351-357. DOI: 10.1097/IAE.0000000000000313.
3. Lim SJ, Kwon YH, Kim SH, et al. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis[J]. Graefe’s Arch Clin Exp Ophthalmol, 2012, 250(11): 1573-1577. DOI: 10.1007/s00417-012-1983-y.
4. Huang D, Swanson EA, Lin CP, et al. Optical coherence tomography[J]. Science, 1991, 254(5035): 1178-1181.
5. 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.1005-1015.2015.04.002.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.1005-1015.2015.04.002.
6. 李楚, 郑文斌, 黄浩, 等.高度近视黄斑劈裂治疗研究进展[J]. 中华眼底病杂志, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.Li C, Zheng WB,Huang H,et al.Progress in the treatment of myopic foveoschisis[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 402-405. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.026.
7. Bando H, Ikuno Y, Choi JS, et al. Ultrastructure of internal limiting membrane in myopic foveoschisis[J]. Am J Ophthalmol, 2005, 139(1): 197-199.
8. Taniuchi S, Hirakata A, Itoh Y, et al. Vitrectomy with or without internal limiting membrane peeling of reach stage of myopic traction maculopathy[J]. Retina, 2013, 33(10): 2018-2025.DOI:10.1097/IAE.0b013e3182a4892b.
9. 马进, 朱铁培, 张倩茹, 等. 高度近视黄斑劈裂视网膜内界膜剥离手术联合全氟丙烷眼内填充疗效评价[J]. 中华眼底病杂志, 2009, 25(5): 341-343. DOI: 10.3670/cma.j.issn.1005-1015.2009.05.05.Ma J, Zhu TP, Zhang QR, et al. Internal limiting membrane peeling and perfluoropropane tamponade for macular retinoschisis with high myopia[J]. Chin J Ocul Fundus Dis, 2009, 25(5): 341-343. DOI: 10.3670/cma.j.issn.1005-1015.2009.05.05.
10. Takano M, Kishi S.Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476.
11. 张娅萍, 毛广运, 王毓琴, 等.后巩膜加固手术治疗病理性近视黄斑劈裂的疗效观察[J]. 中华眼底病杂志, 2015, 31(4): 324-328. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.003.Zhang YP, Mao GY, Wang YQ, et al. The efficacy of posterior scleral reinforcement for macular retinoschisis in pathological myopia[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 324-328. DOI: 10.3670/cma.j.issn.1005-1015.2015.04.003.
12. Baba T, Tanaka S, Maesawa A, et al. Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole[J]. Am J Ophthalmol, 2006, 142(3): 483-487.
13. Zhu Z, Ji X, Zhang J, et al. Posterior scleral reinforcement in the treatment of macular retinoschisis in highly myopic patients[J]. Clin Exp Ophthalmol, 2009, 37(7): 660-663. DOI: 10.1111/j.1442-9071.2009.02111.x.
14. Nakagawa N, Parel JM, Murray TG, et al. Effect of scleral shortening on axial length[J]. Arch Ophthalmol, 2000, 118(7): 965-968.

Chinese Journal of Ocular Fundus Diseases

Clinical observation of vitrectomy combined with internal limiting membrane peeling and scleral shortening for myopic foveoschisis

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