The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
ObjectiveTo observe the efficacy of pars plana vitrectomy (PPV) in the treatment of different types of chorioretinal coloboma with retinal detachment (RD). MethodsA single-center, retrospective clinical study. From April 2021 to March 2023, 24 eyes of 23 patients who were diagnosed as chorioretinal coloboma with RD in Henan Provincial Eye Hospital were included in this study. There were 11 males with 12 eyes and 12 females with 12 eyes. The mean age was (33.3±13.7) years old. Best corrected visual acuity (BCVA), spectral domain optical coherence tomography were performed. The BCVA examination was performed using a international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. According to the types of chorioretinal coloboma, the affected eyes were divided into the coloboma involved the optic disc group and the coloboma not involved the optic disc group, with 15 eyes and 9 eyes. According to whether the RD containing the coloboma area, the affected eyes were divided into RD containing the coloboma area group and the RD not containing the coloboma area group, with 15 eyes and 9 eyes. All eyes underwent standard pars plana three-channel 25G PPV, retinal laser photocoagulation combined with silicone oil tamponade. The follow-up time after surgery was (19.5±16.3) months. The last follow-up was the time point for efficacy determination. The retinal reattachment, BCVA recovery and postoperative complications were observed. Paired t-test or t test was performed for comparison of quantitative data. Fisher's exact test was performed for comparison of qualitative data. ResultsAt the last follow-up, retinal reattachment was achieved in 20 eyes (83.3%, 20/24). The logMAR BCVA of the coloboma involved the optic disc group before and after surgery were 1.85±0.62 and 1.71±0.71, the difference was no significant (t=0.845, P=0.412). The logMAR BCVA of the coloboma not involved the optic disc group before and after surgery were 1.75±0.45 and 0.84±0.26, the difference was statistically significant (t=6.153, P＜0.001). The improvement of BCVA in the coloboma not involved the optic disc group was significantly higher than that in the coloboma involved the optic disc group after surgery, with statistically significant differences (t=3.024, P=0.006). There was no significant difference in the retinal reattachment rate between the two groups (P=0.615). There was no significant difference in the retinal reattachment rate between the RD containing the coloboma area group and the RD not containing the coloboma area group (P=0.259). Postoperative complications included elevated intraocular pressure in five eyes, cataract progression in ten eyes, recurrent RD in two eyes, bullous keratopathy in one eye and band-shaped keratopathy in one eye. ConclusionPPV combined with silicone oil tamponade is safe and effective in the treatment of chorioretinal coloboma with RD, the improvement of visual acuity in the coloboma not involved the optic disc group is better than that in the coloboma involved the optic disc group after surgery.