To investigate the associated factors of foveoschisis and foveal detachment without macular hole in highly myopic eyes. A cross-sectional study of 124 eyes of 68 highly myopic patients was performed. The patients underwent complete ocular examination, fundus photography, and optical coherence tomography (OCT). Of the 124 eyes, 10 (8%, 10/124) had foveoschisis or foveal detachment without a macular hole on OCT examination. On the basis of univariate analysis, six variables were associated with the pathologic changes, including age over 40 years (P=0.018), spherical equivalent over 10 D (P=0.042), axial length over 31 mm (P=0.001), macular chorioretinal atrophy (P=0.00003), posterior staphyloma (P=0.0003), and vitreoretinal interface factors, including epiretinal membrane, posterior vitreoschisis, and vitreomacular traction (P=0.00002). In the multivariate analysis, three factors were independently associated with foveoschisis and foveal detachment without macular hole in high myopia: axial length, macular chorioretinal atrophy, and vitreoretinal interface factors. Foveoschisis and foveal detachment without macular hole are sight-threatening disorders in highly myopic eyes. Axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated with these pathological conditions. Thus, both intraocular and outer ocular wall factors play important roles and merit further study.

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Factors associated with foveoschisis and foveal detachment without macular hole in high myopia.

Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis.

Objective To describe the results of vitrectomy in highly myopic eyes affected by a form of posterior vitreous traction termed myopic traction maculopathy (MTM). Methods In this retrospective case series, 24 highly myopic eyes with MTM underwent vitrectomy and release of vitreoretinal traction without final fluid/gas exchange. Nine eyes (37.5%) received a combined phacovitrectomy. Mean patient age was 58 years, mean refractive error was −16.8 dioptric spherical equivalent, and preoperative visual acuity ranged from 20/400 to 20/32 (mean, 20/80). Mean follow-up was 29.6 months. Results Twenty-three (95.8%) of 24 eyes had complete and stable resolution of MTM after a mean of 4.4 months. Mean visual improvement was 2.5 Snellen lines (range, 0 to 6 lines). Five eyes (20.8%), despite achieving complete retinal flattening, developed a macular hole that did not progress to macular detachment during follow-up. Conclusions Vitrectomy without fluid/gas exchange leads to stable resolution of MTM and good visual improvement. Posterior retinal detachment probably precedes macular hole formation in highly myopic eyes.

https://jamanetwork.com/journals/jamaophthalmology/articlepdf/419300/ecs60078_767_772.pdf

Vitrectomy for myopic traction maculopathy.

The Diversity of Traction Mechanisms in Myopic Traction Maculopathy

PURPOSE The purpose of this study was to determine the factors that are correlated with the visual outcomes in patients who underwent pars plana vitrectomy with internal limiting membrane peeling for myopic foveoschisis (MF). METHODS In this retrospective, interventional consecutive case series, 39 eyes of 39 consecutive patients who had undergone pars plana vitrectomy with internal limiting membrane peeling for MF were studied. Preoperative optical coherence tomography showed that none of the eyes had a macular hole or vitreoretinal traction. Eyes were divided into those with MF and a foveal detachment (FD; FD group, n = 27) and those with MF without an FD (no-FD group, n = 12). The main outcome measures were best-corrected visual acuity (BCVA) and the optical coherence tomography findings. RESULTS Optical coherence tomography showed a complete resolution of the MF with a reattachment of the fovea in all eyes, and the retina remained attached during the mean follow-up of 41 months. The final mean BCVA improved significantly in the FD group (P = 0.0003) but not in the no-FD group (P = 0.56). The final BCVA of the FD group and no-FD group improved in 70% and 42%, remained unchanged in 26% and 33%, and worsened in 4% and 25% of the eyes, respectively. A better final BCVA was significantly correlated with a better preoperative BCVA (P < 0.0001), a shorter axial length (P = 0.045), and the presence of an FD (P = 0.028). CONCLUSION Pars plana vitrectomy with internal limiting membrane peeling results in long-term favorable anatomical and visual outcomes. Eyes with an FD may be good candidates for surgery.

Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis.

Aim: To evaluate the clinical and anatomical outcomes of pars plana vitrectomy and gas tamponade without internal limiting membrane (ILM) peeling in symptomatic patients caused by myopic foveoschisis. Methods: Nine eyes in eight highly myopic patients who had myopic foveoschisis with foveal detachment underwent vitrectomy without ILM peeling followed by gas tamponade. Main outcome measures include change in best corrected visual acuity (BCVA) and changes in height of the foveal detachment and resolution of the myopic foveoschisis measured by optical coherence tomography (OCT). Results: After surgery, BCVA improved in eight eyes with the median BCVA improved from 20/80 to 20/50 (p=0.012). The mean line of visual improvement was 3.6 lines. OCT showed complete resolution of myopic foveoschisis with complete foveal reattachment in seven (77.8% ) eyes with partial resolution in two (22.2% ) eyes. The mean height of foveal detachment decreased from 505 μ m preoperatively to 21 μ m postoperatively (p 0.001). Conclusions: Vitrectomy without ILM peeling followed by gas tamponade appeared to result in favourable visual and anatomical outcomes for treating myopic foveoschisis in highly myopic eyes. The results are comparable with studies in which ILM removal was performed. Further controlled study will be useful to determine the role of ILM peeling in these patients.

K Argyle

Papers

Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis