Therapeutic effects of pars plana vitrectomy combined with internal limiting membrane peeling on high myopic foveoschisis

Abstract

Objective: To observe the clinical efficacy of vitrectomy combined with foveal-sparing circular internal limiting membrane peeling with the central fovea reserved in patients with high myopic foveoschisis. Methods: Case-control study. A total of 72 patients (86 eyes) with foveoschisis due to high myopia who underwent vitrectomy combined with internal limiting membrane peeling in Lishui Municipal Central Hospital of Zhejiang Province from June 2016 to May 2017 were enrolled, including 18 males (18 eyes) and 54 females (68 eyes), aged (50.5±8.9) years. The patients were randomly divided into the observation group (34 cases, 43 eyes) and the control group (38 cases, 43 eyes) using a random number table and random number residual grouping method. Vitrectomy was performed in all patients. In the control group, the limiting membrane in the macular area was removed during surgery. In the observation group, the foveal annular internal limiting membrane was preserved during surgery. In severe cases, cataract extraction was performed. Results: In the observation group, the mean central foveal thickness (CFT) on optical coherence tomography was (723.49±130.95) μm preoperatively and decreased to (286.33±210.73) μm postoperatively, and the difference had statistical significance (t=17.059, P=0.000). In 39 eyes with complete or partial healing of the foveal split, the best corrected visual acuity (BCVA) was (0.99±0.40) logMAR before the treatment and increased to 0.68±0.24 after the treatment, and the difference had statistical significance (t=7.585, P=0.000). In the control group, the mean CFT was (726.98±140.62) μm and (297.88±241.56.) μm before and after the treatment, respectively, and the difference had statistical significance (t=16.271, P=0.000). In 38 eyes with complete or partial healing of the foveal split, the BCVA increased from preoperative 1.04±0.47 to postoperative 0.69±0.21, and the difference had statistical significance (t=6.707, P=0.00). With the follow-up time as the efficacy determination time, there was no significant difference in BCVA (t=0.22, P=0.983) and CFT (t=0.236, P=0.814) between the observation group and the control group (P>0.05); there was significant difference in the incidence rate of macular holes (P=0.026). There was no statistically significant difference in the rate of complete macular morphology healing between the two groups (P=0.816). Conclusion: Vitrectomy combined with foveal-sparing circular internal limiting membrane peeling can effectively treat high myopic macular holes and reduce the formation of postoperative macular holes. (Chin J Ophthalmol, 2020, 56: 928-932).