Vitreomacular Interface Abnormalities in Myopic Foveoschisis: Correlation With Morphological Features and Outcome of Vitrectomy.

Jia Liang,Lu Chen,Shaochong Zhang,Xingxing Mao,Dong Fang,Li Wang,Ting Xie,Kunke Li

doi:10.3389/fmed.2021.796127

Jia Liang, Lu Chen + Show 6 more

Open Access

https://doi.org/10.3389/fmed.2021.796127

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Abstract

Purpose: To compare the morphologic characteristics and response to surgery of myopic foveoschisis (MF) with different patterns of vitreomacular interface abnormalities (VMIAs).Methods: In this observational case series, 158 eyes of 121 MF patients with epiretinal membrane (ERM) or vitreomacular traction (VMT) based on optical coherence tomography (OCT) were enrolled. All the eyes were divided into two groups by the pattern of VMIAs: ERM and VMT group. Sixty-one eyes underwent pars plana vitrectomy (PPV) and were followed up for at least 6 months. The morphologic characteristics based on OCT and the surgical outcome were evaluated.Outcome: ERM and VMT were found in 47.47 and 52.53% of the cases, respectively. A higher rate of foveal detachment (61.4 vs. 26.7%; p < 0.001) and a higher rate of outer lamellar macular hole (45.8 vs. 21.3%; p = 0.001) were detected in the eyes with VMT compared with those with ERM. In contrast, a lower rate of inner lamellar macular hole (28.9 vs. 60.0%; p = 0.001) was detected in the eyes with VMT compared with those with ERM. The disruption of the external limiting membrane (ELM) was more common in the eyes with VMT than in those with ERM (45.8 vs. 21.3%; p = 0.001). PPV was performed in 61 eyes with a mean follow-up time of 23.55 ± 19.92 months. After surgery, anatomical resolution was achieved in 51 eyes (83.6%). At the final visit, the mean central foveal thickness (CFT) decreased significantly from 547.83 to 118.74 μm, and the mean LogMAR BCVA improved significantly from 0.92 to 0.57. The VMT group was associated with a higher proportion of eyes with visual acuity improvement postoperatively (p = 0.02) and had more a decrease of CFT (P = 0.007) compared with the ERM group.Conclusion: In the eyes with MF, outer retinal lesions occurred more frequently in the eyes with VMT, whereas inner retinal lesions occurred more frequently in the eyes with ERM. Tangential force generated by ERM may act as a causative factor for the inner retinal lesions in MF, and inward-directed force resulting from VMT may act as a causative factor for outer retinal lesions in MF.

Highlights

Myopic foveoschisis (MF) is a common sight-threatening complication in patients with high myopia, which is characterized by intraretinal splitting in the macula region
Exclusion criteria were: [1] Presence of full-thickness macular hole, [2] history of ocular trauma or vitreoretinal surgery, including vitrectomy and scleral reinforcement, [3] eyes with any associated or concomitant retinopathy that could confound the retinal interpretation of optical coherence tomography (OCT) images, [4] to dig out the relationship between the subtypes of vitreomacular interface abnormalities (VMIA) and MF, we specially enrolled the eyes with vitreomacular traction (VMT) alone or epiretinal membrane (ERM) alone, and the eyes with both VMIAs were excluded, [5] unclear image of OCT, which was defined as insufficient visualization of the retinal pigment epithelium line in the macular area
All patients were divided into two groups by the pattern of VMIAs based on OCT examination: ERM group and VMT group

Summary

Introduction

Myopic foveoschisis (MF) is a common sight-threatening complication in patients with high myopia, which is characterized by intraretinal splitting in the macula region. The exact pathogenesis of MF has not been clarified, several factors have been found to play a role in the occurrence of MF, including vitreomacular interface abnormalities (VMIA), retinal arteriolar stiffness, globe ectasia and staphyloma. VMIAs including epiretinal membrane (ERM) and vitreomacular traction (VMT) are among the independent factors associated with MF [3]. Different subtypes of VMIAs, with different tomographic presentations, could lead to different tractional forces on retina. In the eyes with VMT, contraction of the preretinal vitreous could lead to a trampoline-like shallow vitreous detachment, which generates anterior traction on the fovea [4]. ERM, presented as a thin and highly reflective epiretinal material in optical coherence tomography (OCT), is proposed to generate tangential forces on the retinal surface [5]

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