Macular Foveoschisis Research Articles

Vitreoretinal Interface Abnormalities in Pathologic Myopia (Myopic Traction Maculopathy)

Myopic traction maculopathy (MTM) is an umbrella term proposed to describe the spectrum of pathologic anatomic changes in the macula of pathologic myopic eyes, including vitreomacular traction, macular foveoschisis and myopic macular hole, affecting a large proportion of eyes with pathologic myopia. In this review, we aim to share information about the diagnosis, clinical features and treatment of MTM.

A Novel Technique Using Lyophilized Amniotic Membrane Patch (LAMPatch) as Primary Procedure in Patients with Myopic Traction Maculopathy with Macular Detachment.

Maculopathy secondary to pathologic myopia (PM) is increasingly causing visual impairment and blindness worldwide. PM is associated with tractional maculopathy that ranges from macular foveoschisis to macular hole. These disorders are treated with different options that offer variable results, reflecting the need for new techniques that address myopic maculopathy with consistent outcomes. Since human amniotic membrane (HAM) has been reported to be safe for intraocular use and to promote retinal healing, it was incorporated as an adjuvant in pars plana vitrectomy in patients with different tractional disorders related to myopia. This work presents a prospective, consecutive case series of seven patients with high myopia who underwent a 25-gauge vitrectomy with ILM peeling and HAM transplantation. Our six-month results show that this novel technique delivers functional success related to tissue permanence without recurrence of traction that translates into visual acuity gain and maintenance that are superior to other techniques.

Advancements in Myopic Macular Foveoschisis Research.

Presently, the global prevalence of myopia and high myopia reaches approximately 1.95 billion and 277 million individuals, respectively. Projections suggest that by 2050, the number of people with myopia may rise to 4.758 billion and those with high myopia to 938 million. In highly myopic eyes, the occurrence of MF is reported to be as high as 8-33%. This review comprehensively addresses the classification, pathogenesis, natural progression, concomitant pathologies, and therapeutic strategies for macular foveoschisis in highly myopic patients. In recent years, macular foveoschisis has emerged as a prevalent complication in individuals with high myopia, primarily resulting from the combination of inward traction by vitreoretinal adhesions and outward traction exerted by posterior scleral staphyloma on the retina. While some maintain partial visual stability over an extended period, others may progress to macular holes or even retinal detachment. For highly myopic patients with macular foveoschisis, the mainstay procedures are vitrectomy, macular buckle, and posterior scleral reinforcement. However, there is controversy about whether to perform inner limiting membrane peeling and gas filling.

Vitrectomy for Macular Hole with Macular Foveoschisis in Myopic Tractional Maculopathy PPV for MH-MFS

Background: Macular Hole with Macular Foveoschisis (MH-MFS) represents one of the end stages of Myopic Traction Maculopathy (MTM). This study demonstrates the effectiveness of Pars Plana Vitrectomy (PPV) with appropriate Internal Limiting Membrane (ILM) peeling and use of an ILM flap without the conventional use of macular buckle for resolving this condition. Methods: Twelve highly myopic eyes with MH-MFS underwent PPV in a single institution. Careful fovea sparing Inner Limiting Membrane (ILM) peeling with inverted flap under repeated re-staining with brilliant blue was performed. Best Corrected Visual Acuity (BCVA) and rate of Macular Hole (MH) closure, as measured by Optic Coherence Tomography. Results: Primary MH closure was obtained in 90.9% of the cases. Best Corrected Visual Acuity (BCVA) improved in 9 patients (75%) from a baseline BCVA of 0.59 ± 0.26 log MAR (20/77) to a post-operatory BCVA of 0.35 ± 0.25 log MAR (20/44) with statistical significance (p=0.004). Foveoschisis resolution occurred as follows: 6 cases within the first month, and 9 cases by the first year. Partial resolution was achieved in 2 cases, while one failed to resolve during follow-up. Conclusions: PPV with ILM peeling and inverted flap is a safe and effective method for managing MH-MFS. Careful identification of ILM and a thorough understanding of the vitreomacular interface abnormalities is key to surgical success.

X-linked Retinoschisis Associated with Retinitis Punctata Albescens Caused by a Mutation in the RS1 Gene: A Family Study

Purpose: To describe the clinical and genetic characteristics (mutation in RS1 gene) of a Spanish family with X-linked retinoschisis (XLRS) associated with retinitis punctata albescens (RPA). Methods: The detailed ophthalmological examination included best corrected visual acuity (BCVA), colour and autofluorescence photography, fluorescein angiography, optical coherence tomography and electrophysiology tests. A next-generation sequencing (NGS) strategy was applied to the index patient, and then sequenced in an Illumina NextSeq500 system. Candidate variants considered to be disease-causing in the patient were confirmed and segregated in the family by Sanger sequencing. Results: We have studied three siblings of 54, 59 and 50 years old. Two of them presented with macular foveoschisis and a whitish mottling of the pigment epithelium in the peripheral and equatorial retina, while the other had macular atrophy. Electroretinography revealed a reduced b-wave, while a-wave remained unchanged. Mutation in RS1 (c.98G>A; p.Trp33*) was identified as the cause of the disease. Conclusion: XLRS is a genetic disease that leads to irreversible visual loss. We describe an unusual phenotype manifestation of a known mutation.

FOVEA-SPARING VERSUS COMPLETE INTERNAL LIMITING MEMBRANE PEELING IN VITRECTOMY FOR VITREOMACULAR INTERFACE DISEASES: A Systematic Review and Meta-Analysis.

To evaluate fovea-sparing internal limiting membrane (ILM) peeling in vitrectomy compared with traditional complete ILM peeling in vitreomacular interface diseases, including macular hole (MH), epiretinal membrane, macular foveoschisis, myopic traction maculopathy, and the like. PubMed, EMBASE, Cochrane, CNKI Databases, and the ClinicalTrials.gov website (PROSPERO number CRD42020187401) were searched. Controlled trials comparing fovea-sparing with complete ILM peeling were included. Postoperative changes in best-corrected visual acuity, central retinal thickness in vitreomacular interface diseases, the incidence of MH closure in MH cases, full-thickness macular hole development in non-MH cases, and retinal reattachment in retinoschisis cases were extracted. Fourteen studies (487 eyes) were eligible. Compared with complete ILM peeling, the fovea-sparing technique revealed significant improvement in best-corrected visual acuity ( logarithm of the minimum angle of resolution; weighted mean difference = -0.70; 95% confidence interval, -1.11 to -0.30), and a reduced incidence of full-thickness macular hole was noted in non-MH cases (risk ratios = 0.25; 95% confidence interval, 0.08-0.76). However, no significant differences in mean change in central retinal thickness, incidence of MH closure in MH cases, and retinal reattachment in retinoschisis cases were noted. Based on current evidence, fovea-sparing ILM peeling significantly improve visual outcomes and decrease complications of full-thickness macular hole development in vitreomacular interface diseases.

Individualized Ophthalmic Exoplants by Means of Reverse Engineering and 3D Printing Technologies for Treating High Myopia Complications with Macular Buckles

Myopic macular foveoschisis maculopathy is an eye disease that is treated, in most cases, with surgical intervention, in which a macular buckle is applied to restore eye anatomy and functionality. A macular buckle is a type of exoplant that comes in various designs and sizes. Often, they are difficult to apply or they do not fit properly in the eye geometry since they have a generic form. In this work, the effort to develop the most suitable tailor-made macular buckle for each individual patient for treating myopic traction maculopathy is studied. Pattern recognition techniques are applied to the patient’s Computed Tomography (CT) data to develop the exact 3D geometry of the eye. Using this 3D geometry, the trajectory of the buckle is fitted and the buckle is formed, which is then 3D-printed with biocompatible polymer materials. It is expected that the power of technology will be used to activate the most precise approach for each individual patient. Considering the possible complications and technical difficulties of other surgical methods, the customized macular buckle is an appropriate, easy-to-use, and most precise piece of medical equipment for the treatment of myopic traction maculopathy.

Comparision of the clinical effects on vitrectomy with or without fovea-sparing internal limiting membrane peeling

Objective To evaluate the clinical effects of vitrectomy with or without fovea-sparing internal limiting membrane peeling on macular foveoschisis (MF) secondary to pathologic myopia. Methods A non-randomized controlled study was adopted.Twenty-three patients (25 eyes) with refractive error ≥-8.00 DS and MF either combined with foveal retinal detachment or epi-macualr membrane or lamellar macular hole.The subjects were divided into non-internal limiting membrane peeling group (11 patients /11 eyes) who underwent triamcinolone (TA) assisted vitrectomy and fovea-sparing internal limiting membrane peeling group (12 patients/14 eyes) who underwent TA assisted vitrectomy with fovea-sparing internal limiting membrane peeling.The baseline data such as age, best corrected visual acuity (BCVA), refractive error, axial length were not significant difference between the two group.Main outcomes were BCVA, remission of MF defined by optical coherence tomographyc OCT as well as complications.This study followed the Declaration of Helsinki and this protocol was approved by Ethic Committee of Xiamen Eye Center of Xiamen University (NO.XMYKZX-2016-YWS-007). Results All patients completed follow-up for more 6 months.BCVA (LogMAR) was 0.47±0.30 in non-internal limiting membrane peeling group and 0.40±0.33 in fovea-sparing internal limiting membrane peeling group, showing no significant difference between the two groups (t=0.66, P=0.52). Complete remission of MF was achieved in 22 eyes.The remission time in non-internal limiting membrane peeling group was 2.5 (1.8, 9.3) months, and 1.0 (1.0, 3.8) months in fovea-sparing internal limiting membrane peeling group, no statistical significance was obtained between the two groups (U=35.00, P=0.09). One eye had post-operative macular hole in non-internal limiting membrane peeling group, accounting for 9%, while in fovea-sparing internal limiting membrane peeling group, one eye had macular hole, accounting for 7%, and one eye had rhegmatogenous retinal detachment post-operatively, accounting for 7%. Conclusions MF can be resolved by vitrectomy while complete remission can achieved more quickly when combined with fovea-sparing internal limiting membrane peeling. Key words: Myopia, pathologic/surgery; Foveoschisis; Vitrectomy; Internal limiting membrane; Outcome

VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING AND AIR TAMPONADE FOR MYOPIC FOVEOSCHISIS.

To evaluate the functional and anatomical outcomes of 23-gauge or 25-gauge pars plana vitrectomy with internal limiting membrane peeling and air tamponade for the treatment of myopic foveoschisis. Retrospective, noncomparative, interventional case series. The records of 29 patients (32 eyes), with myopic foveoschisis who were treated by 23-gauge or 25-gauge 3-port pars plana vitrectomy with internal limiting membrane peeling and air tamponade, were reviewed. At each visit, a complete ophthalmic examination, intraocular pressure, best-corrected visual acuity, and central foveal thickness measured using optical coherence tomography were assessed. Twenty-five eyes of 23 patients (M:F = 4:19) matched the inclusion criteria, whereas 7 eyes of 6 patients were excluded. The mean logarithm of the minimum angle of resolution best-corrected visual acuity (Snellen equivalent) was 0.62 (20/80) (SE: 0.061), and the mean preoperative central foveal thickness was 619.5 µm (SE: 16.38) at baseline. Visual acuity significantly improved of 5 Early Treatment Diabetic Retinopathy Study letters (45 letters) at the 1-month follow-up (P < 0.001), 2 lines (50 Early Treatment Diabetic Retinopathy Study letters) at the 6-month follow-up (P < 0.001), and it reached 55 Early Treatment Diabetic Retinopathy Study letters at the 1-year follow-up visit (P < 0.001). Central foveal thickness decreased to 292.4 µm (SE: 15.93), to 227.3 µm (SE: 14.05), and to 208.8 µm (SE: 12.86), respectively, at the 1-, 6-, and 12-month follow-ups (for each P < 0.001). There were no differences in best-corrected visual acuity or central foveal thickness changes between the foveal detachment group and the nonfoveal detachment group (P > 0.05). Small-gauge vitrectomy with internal limiting membrane peeling and air tamponade results in favorable anatomical and functional outcomes for patients affected by myopic macular foveoschisis.

INDICATIONS AND RESULTS OF A NEW L-SHAPED MACULAR BUCKLE TO SUPPORT A POSTERIOR STAPHYLOMA IN HIGH MYOPIA.

The efficacy of a macular buckle in treating myopic traction maculopathy was studied. Fifty eyes with myopic traction maculopathy, in the form of macular detachment with macular hole (MHMD), or without macular hole (MD) and macular foveoschisis (MF), were treated with vitrectomy combined with macular buckle or with a macular buckle without vitrectomy. Combined group: The combined group comprised 10 eyes with MHMD, 6 eyes with MD, and 4 eyes with MF. The retina was attached in 100% of MD and MHMD and the MF was improved in 100% of cases. The hole was closed in 60% of MHMD. The mean initial and final Snellen best-corrected visual acuity was 20/500 and 20/100 for MHMD, 20/200 and 20/60 for MD, and 20/200 and 20/50 for MF. The mean surgical time was 80 ± 35 minutes. Fundus angiography or indocyanine green revealed no alteration of the chorioretinal blood flow. Buckle shortening was required in 6/20 (30% of cases) patients for lateral extrusion of the sponge through the conjunctiva with the first sponge model. This complication was overcome by changing the arm of the buckle. Buckle group: The buckle group comprised 5 eyes with MHMD, 11 with MD, and 14 with MF. The retina was attached in 100% of MHMD, MD, and MF. The macular hole was closed in 60%. The mean initial and final Snellen best-corrected visual acuity was 20/800 and 20/60 for MHMD, 20/125 and 20/50 for MD, and 20/200 and 20/63 for MF. The mean postoperative decrement in axial length was 1.21 mm. The mean surgical time was 35 ± 15 minutes. Fundus angiography or indocyanine green revealed no alteration of the chorioretinal blood flow. Complications included conjunctiva erosion (15%), diplopia (7.7%), and pain (3.8%). Magnetic resonance imaging showed flattening of the posterior staphyloma. Considering the possible complications and technical difficulties of vitrectomy, we suggest that the macular buckle alone should be the first treatment of myopic traction maculopathy. Vitrectomy should be reserved only for cases of tangential tractions.

Intraocular Gas Treatment for Myopic Foveoschisis

To report a case of symptomatic myopic retinoschisis with foveolar detachment and lamellar macular hole, treated with expansible gas. Interventional case report. A myopic patient presented with a history of decreased vision and metamorphopsia in his right eye. Optical coherence tomography (OCT) revealed an increased macular thickness, thinning and separation of the inner and external retina (retinoschisis or foveoschisis), foveolar detachment, lamellar hole, and foveolar vitreous traction. We treated the patient with a single dose of 0.2 mL of perfluoroethane (C2F6), performed under retrobulbar anesthesia, followed by prone posturing for 15 days. OCT showed reattachment of the foveolar retina, disappearance of the retinoschisis, and visual acuity improvement. Intraocular expansible gas and prone posturing, without vitrectomy, could be an alternative treatment in selected cases of symptomatic macular foveoschisis with foveolar detachment, in the absence of dense epiretinal membranes.

Pathology of Macular Foveoschisis Associated with Degenerative Myopia

This is a clinicopathological paper on the histologic findings in myopia-associated macular foveoschisis. The findings on ophthalmic pathological study of a 73-year-old woman with high myopia are reviewed. Multiple retinoschisis cavities involving both the macula and retinal periphery were disclosed. Our paper offers tissue evidence and supports recent ocular coherence tomography reports of eyes with high myopia and associated macular foveoschisis.

Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes

To report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long-acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow-up periods of > or = 12 months. Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.