Combining 3D heads-up display viewing system and intraoperative optical coherence tomography-assisted vitrectomy for myopic foveoschisis_Chinese Journal of Ocular Fundus Diseases

Authors：

 Zhang Chun , Chen Xiuju , Liu Mingwei , Luo Xiangdong , Li Xiaoxin

Xiamen Eye Center of Xiamen University, Xiamen 361000, China;

Corresponding author：

Zhang Chun, Email: macular@126.com

Keywords：

Vitreoretinal surgery/instrumentation; Tomography, optical coherence; Retinoschisis/surgery; Myopia, degenerative/complications; 3D heads-up display viewing system

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.002

Video：

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Objective To observe the clinical efficacy of digital 3D heads-up display viewing system (3D viewing system) and intraoperative OCT (iOCT) in vitrectomy for myopic foveoschisis (MF).Methods A retrospective, consecutive case series. From October 2018 to May 2019, Nineteen eyes of 19 consecutive patients with MF diagnosed in Xiamen Eye Center of Xiamen University who underwent vitrectomy were included in this study. There were 7 males and 12 females, with the mean age of 54.47±11.38 years. The average axial length was 30.40±2.30 mm, the mean logMAR BCVA was 0.56±0.31, the mean central foveal thickness (CFT) was 317.80±151.9.32 μm, the mean max retinal thickness (maxRT) was 556.7±143.7 μm. All the surgeries performed combined with 3D viewing system with iOCT. The standard 25G pars planar vitrectomy were performed with removing the posterior vitreous and indocyanine green (ICG) staining of internal limiting membrane (ILM) and air-fluid exchange. Thirteen of 19 eyes underwent fovea-sparing ILM peeling and the other 6 eyes not. The average follow-up was 4.2±1.4 months. All the patients were on regular follow-up to document the changes on BCVA, anatomical changes in macula, CFT and maxRT. Paired t test was used to compare BCVA, CFT and maxRT before and after surgery.Results The fine images of macula were clearly shown on the 3D viewing system in all eyes. The electronic green filter enhanced the contrast sensitivity of ICG stained images. Clear images of macula were captured by iOCT in all eyes. The average surgical time was 35.5±8.2 min. On the last follow-up, 16 of 19 eyes with MF resolved. The mean CFT was 178.5±103.5 μm, the maxRT was 341.8±83.8.16 μm, and the mean logMAR BCVA was 0.35±0.22. The differences of CFT, maxRT and logMAR BCVA before and after surgery were statistically significant (t=4.181, 7.154, 5.129; P＜0.001). Minimal invisible full thickness macular hole were detected in 2 eyes by iOCT and repaired with auto serum or ILM flap covering. There was no complication associated with the 3D viewing system.Conclusions 3D viewing system provides improved contrast and crystal clear macular image stain with ICG in pathological myopia. iOCT can detect the minimal invisible full thickness macular hole during surgery. Both may contribute to improved MF closure rate and BCVA.

Citation： Zhang Chun, Chen Xiuju, Liu Mingwei, Luo Xiangdong, Li Xiaoxin. Combining 3D heads-up display viewing system and intraoperative optical coherence tomography-assisted vitrectomy for myopic foveoschisis. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 529-533. doi: 10.3760/cma.j.issn.1005-1015.2019.06.002 Copy

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1. Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: an experimental and clinical study[J]. Retina, 2016, 36(1): 137-147. DOI: 10.1097/IAE.0000000000000689.
2. Ehlers JP, Modi YS, Pecen PE, et al. The discover study 3-year results: feasibility and usefulness of microscope-integrated intraoperative OCT during ophthalmic surgery[J]. Ophthalmology, 2018, 125(7): 1014-1027. DOI: 10.1016/j.ophtha.2017.12.037.
3. Ikuno Y, Sayanagi K, Ohji M, et al. Vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Am J Ophthalmol, 2004, 137(4): 719-724. DOI: 10.1018/j.ajo.2003.10.019.
4. Ohno-Matsui K, Lai TY, Lai CC, et al. Updates of pathologic myopia[J]. Prog Retin Eye Res, 2016, 52: 156-187. DOI: 10.1016/j.preteyeres.2015.12.001.
5. Rodrigues IA, Stangos AN, Mchugh DA, et al. Intravitreal injection of expansile perfluoropropane (C₃F₈) for the treatment of vitreomacular traction[J]. Am J Ophthalmol, 2013, 155(2): 270-276. DOI: 10.1016/j.ajo.2012.08.018.
6. Mii M, Matsuoka M, Matsuyama K, et al. Favorable anatomic and visual outcomes with 25-gauge vitrectomy for myopic foveoschisis[J]. Clin Ophthalmol, 2014, 8: 1837-1844. DOI: 10.2147/OPTH.S67619.
7. Hirakata A, Hida T. Vitrectomy for myopic posterior retinoschisis or foveal detachment[J]. Jpn J Ophthalmol, 2006, 50(1): 53-61. DOI: 10.1007/s10384-005-0270-4.
8. Kwok AK, Lai TY, Yip WW. Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis[J]. Br J Ophthalmol, 2005, 89(9): 1180-1183. DOI: 10.1016/j.ajo.2011.07.007.
9. Qi Y, Duan AL, Meng X, et al. Vitrectomy without inner limiting membrane peeling for macular retinoschisis in highly myopic eyes[J]. Retina, 2016, 36(5): 953-956. DOI: 10.1097/IAE.0000000000000826.
10. Yeh SI, Chang WC, Chen LJ. Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2008, 86(2): 219-24. DOI: 10.1111/j.1600-0420.2007.00974.x.
11. Itoh Y, Inoue M, Kato Y, et al. Alterations of foveal architecture during vitrectomy for myopic retinoschisis identified by intraoperative optical coherence tomography[J]. Ophthalmologica, 2019, 242(2): 87-97. DOI: 10.1159/000500362.
12. Bruyere E, Philippakis E, Dupas B, et al. Benefit of intraoperative optical coherence tomography for vitreomacular surgery in highly myopic eyes[J]. Retina, 2018, 38(10): 2035-2044. DOI: 10.1097/IAE.0000000000001827.

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Combining 3D heads-up display viewing system and intraoperative optical coherence tomography-assisted vitrectomy for myopic foveoschisis

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