Abstract
Purpose To investigate the efficacy of management of high myopic foveoschisis (MF) with a modified surgical technique of arc-shaped foldback fovea-sparing internal limiting membrane (ILM) peeling. Methods A 23-gauge vitrectomy was performed in five patients with high MF. A long strip of ILM was peeled at the temporal side of the central fovea. Next, an ILM forceps was used to grasp the outer side of the ILM flap, and it was moved forward slowly from the outside to the paracentral fovea, followed by folding ILM back in an arc-shaped manner and then removing it. The above operations were repeated, and all ILM flaps were removed from the outside to paracentral fovea until a narrow strip of ILM remained. Finally, the narrow strip of ILM was excised using a vitreous cutter. Results At the patients' last visits, the foveoschisis almost disappeared completely and the fovea reattached. The central macular thickness statistically decreased from 399.0 ± 96.33 μm preoperatively to 164.60 ± 34.20 μm postoperatively (t = 4.289; P=0.013). The preoperative mean logarithm of the minimum angle of resolution best-corrected visual acuity (1.64 ± 0.65) significantly improved to 0.72 ± 0.18 postoperatively (t = 3.265, P=0.031). The average follow-up time was 11.80 ± 3.35 months (range; 8–16 months). Conclusion The arc-shaped foldback fovea-sparing ILM peeling technique for high MF is safe and effective.
Highlights
High myopic foveoschisis (MF) is a common complication of pathologic high myopia, and its incidence ranges from 9% to 34% [1]
High myopic foveoschisis can be divided into three types: inner foveoschisis, outer foveoschisis, and mixed foveoschisis. e formation of foveoschisis has a serious impact on central vision acuity
A high risk of the postoperative development of fullthickness macular hole (MH) and macular hole retinal detachment (MHRD) was observed after myopic foveoschisis surgery due to complete peeling of the posterior pole internal limiting membrane (ILM) off from the fovea. e risks of full-thickness MH after ILM peeling was reportedly 16.7%–20.8% [3, 4], and MHRD was 5.3% (7/131) [1]. e present report describes an effective ILM peeling technique that leaves the epifoveolar tissue in situ and prevents the development of a macular hole
Summary
High myopic foveoschisis (MF) is a common complication of pathologic high myopia, and its incidence ranges from 9% to 34% [1]. A high risk of the postoperative development of fullthickness macular hole (MH) and macular hole retinal detachment (MHRD) was observed after myopic foveoschisis surgery due to complete peeling of the posterior pole ILM off from the fovea.
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