Macular vitreoretinal interface abnormalities in highly myopic eyes are among the most visionthreatening diseases associated with macular retinal schisis and macular holes. To relieve the traction of the posterior vitreous cortex and to recover the anatomy of fovea for good central vision are the keys to successful repair. However, there are many controversial issues in the efficacy of the surgerical procedures including gas injection, scleral buckling and vitrectomy. How to evaluate these different surgeries and to establish standard surgical procedure options for macular vitreoretinal interface abnormalities in highly myopic eyes needs to be explored.
Objective To evaluate the safety and efficacy of brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling on pathological myopic macular holes with retinal detachment.Methods This is a prospective and noncontrolled study. Twenty-seven high myopia patients （27 eyes） with macular holes and retinal detachment were enrolled. Routine examination was performed, including the best corrected visual acuity （BCVA）, intraocular pressure, slit lamp microscope with +90 D pre-set lens, A- or B-ultrasound,optical coherence tomography (OCT) and visual field. All patients received vitrectomy with BBG-assisted ILM peeling and C3F8 gas tamponade. The 5 followup visits were at the first day, the seventh day, the first month, the third month and the sixth month after surgery. The BCVA, intraocular pressure, visual field, macular hole and retinal reattachment were comparatively analyzed.Results The ILM of all patients were peeled completely by BBG staining. There were no major complications such as corneal edema, anterior chamber reaction, elevated intraocular pressure, visual field defects. At the first month after surgery, macular hole closed and retina reattached in 26 eyes （96.3%）, the macular hole did not close and retina redetached in one eye （25.9%）. At the sixth month after surgery, BCVA of 25 eyes （92.6%） increased, two eyes （7.4%） didnprime;t change, the difference was statistically significant （t＝6.08，Plt;0.05）.Conclusions BBG can fully stain ILM without any side effects. Vitrectomy with BBG-assisted ILM peeling is a safe and effective treatment for pathological myopic macular holes with retinal detachment.
Objective To investigate the distribution of the preferred retinal locus (PRL) of eccentric fixation in eyes with high myopia.Methods A total of 40 highly myopic patients (54 eyes ) with eccentric fixation were examined by MP1 microperimeter to identify the PRL. The position of PRL relative to the fovea was estimated using the 90% confidence ellipse of normal adult foveal fixation. The differences of visual acuity between ldquo;desirablerdquo; and ldquo;undesirablerdquo; PRL were tested by analysis of variance.Results In 54 eyes with high myopia, 24 eyes (44.44%) had PRL of eccentric fixation below the scotoma after loss of central vision; 19 eyes ( 35.19% ) had a leftfield PRL; 6 eyes ( 11.11% ) had an upperfield PRL; and 5 eyes ( 9.26% ) had rightfield PRL. In 14 patients who had binocular eccentric fixation, 13 had the same fixation pattern in both eyes, including lowerfield PRL in 7 （50.00%）, leftfield PRL in 5 （35.71%）, and upperfield PRL in 1 patient （7.14%）. The difference of visual acuity between lower and leftfield PRL group and right and upperfield undesirable PRL group was not statistically significant（F=0.144, Pgt;0.05）. Conclusions The eccentric fixation in eyes with high myopia is usually situated as near as possible to the fovea. The optimal PRL is inferior visual field.
Objective To observe the the clinical characteristics of images of optic coherence tomography (OCT) in highly myopic eyes with retinoschisis. Methods The clincial data of 158 patients (158 eyes) with high myopia diagnosed by examinations of best corrected visual acuity and refraction, indirect stereoscopic ophthalmoloscopy, A/Bscan ultrasonography, and OCT, were retrospectively analyzed. The patients were divided into retinoschisis group and nonretinoschisis group according to the results of OCT (whether the patients had macular reinoschisis at the posterior pole). There were 53 patients (55 eyes, 34.8%) in the former group, and 101 patients (103 eyes, 65.2%) in the latter group. The age, sex, diopter, visual acuity, ocular axial length, and incidence of posterior scleral staphyloma, vitreous traction, and retinal detachment of the two groups were compared. Results B-scan ultrasonography showed posterior scleral staphloma in all of the 158 eyes. OCT indicated that in the 55 eyes in the retinnoschisis group, 15 （27.3%） had inner, 53 （96.4%）had outer, and 7 （12.7%）had middle retinoschisis. The inner and outer one could exist independently or in the same eye, while the middle one was always accompanied by the outer retinoschisis. Two or more types of schisis coexisted in 13 eyes （23.6%）, single outer retinoschisis was found in 40 eyes （72.7%）, and single inner retinoschisis was found in 2 eyes （3.6%）. There were 26 eyes（47.3%）were accompanied with retinal detachment, 13 eyes（23.6%） with macular hole, and 12 eyes （21.8%）with vitreous traction. In the 103 eyes in the nonretinoschisis group， 23 eyes （22.3%）had vitreous traction, 19 eyes （18.4%） had macular hole, and 21 eyes （20.4%）had retinal detachment. The differences of age, diopter and ocular axial length, sex, incidence of macular hole and vitreous traction between the two groups were not statistically significant (Pgt;005）. The visual acuity in retinoschisis group was much lower than that in the nonretinoschisis group （Plt;005）, and the difference of incidence of the retinal detachment between the two groups was significant (Plt;001). 〖WTHZ〗Conclusion 〖WTBZ〗Macular retinoschisis in eyes with high myopia can exist in inner or middle retina, but most of them locate at outer retina.The patients always have poor visual acuity and are often accompanied by other macular lesions such as retinal detachment.
Objective To observe the therapeutic effect of pars plana vitrectomy (PPV) on myopic traction maculopathy (MTM).Methods The clinical data of 31 eyes of 29 patients with MTM diagnosed by timedomain optical coherence tomography (TDOCT) and slitlamp ophthalmoscopy were retrospectively analyzed. The cases were divided into 2 groups according to the stage of MTM: 12 eyes of 10 patients at the early stage of MTM were in group 1; 19 eyes of patients at the most Advanced stage of MTM were in group 2. All of these eyes had undergone PPV with 10％15％ inert gas filling. The patients were followed postoperatively for 6 to 12 months with the average of 8 months, and the best corrected visual acuity, reattachment of macular and retina was examined. Results The improvement rate of visual acuity after surgery for 6 months was 100% in group 1, and 63.2% in group 2 had (12/19); the visual acuity in group 1 was apparently better than that in group 2 (Z=-5477, P=0000). The macular hole disappeared without exposure of the pigment epithelium in all eyes of Group 1, but only 3 eyes in Group 2. For Group 2 patients, 3 eyes had reattached retina with macular holes, and 3 eyes had detached retina with macular holes. The recovery of macular configuration in Group 1 was obviously better than that in Group 2 (Z=-4318, P=0000). Conclusion The surgical intervention of MTM before the formation of macular hole and retinal detachment may prevent the formation of macular holes.
Objective To evaluate the efficacy of vitrectomy with internal limiting membrane（ILM）peeling and perfluoropropane tamponade (C3F8) to treat macular retinoschisis in high myopic eyes.Methods 33 eyes of 31 consecutive high myopia patients with macular retinoschisis were selected randomly; all had posterior staphyloma without retinal detachment. The preoperative refractive errors ranged from －9.5D to －21.0 D with the mean of －(13.1plusmn;3.6) D. The preoperative axial lengths ranged form 26 mm to 32 mm with the mean of (28.3plusmn;2.1) mm. Conventional 20G vitrectomy was performed with ILM peeling and 10% C3F8 infusion, ILM was labeled by Triamcinolone (TA). The best corrected visual acuity (BCVA) and macular structural changes were observed before the surgery, and at 1, 2, 3, 4, 8 months after the surgery. Results Beginning from 1 month after surgery all patients had significant improvement of the macular retinoschisis and BCVA. The macular structure changed very slightly along with the time. The foveal thickness were (327.6plusmn;51.7),(165.2plusmn;22.6),(159.3plusmn;28.7),(167.7plusmn;17.1),(142.7plusmn;13.8) and (169.1plusmn;19.6) mu;m respectively before surgery and 1, 2, 3, 4, 8 months after surgery. The mean foveal thickness was reduced significantly at 18 months followup compared with the preoperational result (t=9.21，9.23，9.21，10.67，9.21; Plt;0.05). The foveal thickness had no significant change at each timepoint after surgery.From 4 months after surgery, recurrence of macular retionoschisis was found in 3 eyes (9.1%).Conclusion Vitrectomy with ILM peeling and C3F8 tamponade is useful to treat macular retinoschisis in high myopic eyes.
Objective To evaluate the therapeutic effects of vitrectomy with internal limiting membrane (ILM) peeling on retinal detachment in eyes with high myopia. Methods The clinical data of 25 high myopia patients (25 eyes) with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment:13 patients in group A had undergone conventional vitrectomy;12 patients in group B had undergone vitrectomy and ILM peeling.All patients had been tamponaded by inert gas and kept in a facedown position for 7-15 days after the operation. The followup period was 6-18 months (average 10 months).LogMAR visual acuity, ocular fundus, B-scan ultrasonography and optical coherence tomography had been followed up.Results Retinal reattachment was found in 7 eyes (53.8%) in group A and 11 eyes in group B (91.7%), the difference was significant(chi;2=4.427, P=0.046).The macular hole closed in 6 eyes (46.2%) in group A, and 11 eyes (91.7%) in group B; the difference was significant between those two groups (chi;2=5.940，P=0.020). The postoperative visual acuity increased significantly in both groups(Z=-2.045,2.481;P=0.041,0.012), the difference of vision improvement was not significant between those two groups (MannWhitnay U＝51.5，P=0.16). Conclusions By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia.
Objective To investigate the histological changes of the internal limiting membrane (ILM) in pathological myopic eyes, and the relationships between those changes and the formation of macular hole.Methods The clinical data of 34 patients （34 eyes）with pathological myopia and macular hole, who had undergone vitrectomy were retrospectively analyzed. All the patients had a diopter over -6.00 D, their ocular axial length ranged from 26.00 to 33.12 mm with an average of 27.74 mm. There were 5 eyes without retinal detachment （macular hole group）while the other 29 eyes all had posterior retinal detachment（RD group）. A standard threeport pars plana vitrectomy was performed in all eyes. The existence of Weiss ring was considered as the sign of posterior vitreous detachment. The epiretinal membranes from 34 eyes and ILM specimens from 19 eyes were stained by hematoxylineosin (HE) and acetate uranyl acetatelead citrate, and then investigated under optical microscope and transmission electron microscope. Results The Weiss ring was observed in 5 eyes during the surgery, multilayer of vitreous tissue resides on the retinal surface in 24 eyes. The results of optical microscope showed that the epiretinal membranes were composed of vitreous collagen, astrocytes and extracellular matrixes. The results from transmission electron microscope showed a sandwich structure (ILMvitreous collagencells) in 5 eyes, and ILM damage, surface traction and astrocytes migration in 1 eye. Conclusions Splitting of posterior surface of vitreous and surface structure change of ILM are the major mechanisms for the formation and progression of macular holes, and even retinal detachment in high myopic eyes.
High myopia is frequently associated with retinal degenerative changes (such as myopic foveoschisis, macular hole and its related retinal detachment, and choroidal neovascularization) which are the major causes of visual loss in high myopic eyes. Optical coherence tomography may help us to understand the macular lesions in high myopia. Peeling of internal limiting membrane and removal of posterior vitreous cortex at an appropriate time, are believed to facilitate restoring the retinal flexibility and resolution of myopic foveoschisis, and promote the macular hole closure and retinal reattachment. Antiangiogenesis treatment combined with photodynamic therapy and (or) corticosteroid therapy are the future options to treat myopic choroidal neovascularization. Correctly understanding and mastering the methods and timing of diagnosis and treatment of high myopiarelated macular degeneration, and taking targeted interventions to enable patients to be rational and effective treated, are the keys to further reduce the damage of visual function in patients with high myopia.