First Author: L.Lu CHINA
Co Author(s): B. Liu Y. Li W. Ma S. Tanumiharjo F. Sallo C. Jin
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To investigate the natural progression of myopic macular retinoschisis (MS).
This is a retrospective observational case series study. A cohort of 406 eyes showing MS on optical coherence tomography (OCT) with a refractive error ≤ -6.0 diopter or an axial length ≥ 26.0mm were included.
Stages of MS were defined according to the sequence of anatomical landmark changes on OCT: Stage Ia: extrafoveal MS; stage Ib: fovea-involved MS; stage Ic: extensive MS; stage IIa: fovea-involved MS and inner lamellar macular hole; stage IIb: fovea-involved MS and foveal detachment (FD); stage IIIa: MS and full-thickness macular hole (FTMH) without prominent macular detachment (MD); stage IIIb: MS and MD without FTMH; and stage IV: MS, prominent MD, and FTMH. The progression pattern and visual prognosis of myopic MS was analyzed.
Cross sectional baseline data showed that the mean best corrected visual acuity (BCVA) in stage I was higher than stage II (p<0.05), and the BCVA in stage I/II was higher than stage III/IV (p<0.001), but there was no statistically significant difference between stage III and stage IV. In our cohort, 152 eyes were followed for more than 6 months, of which 49 eyes (32.24%) showed progression, 9 (5.92%) showed improvement, and 94 (61.84%) showed stable OCT features. The BCVA decreased significantly in both the OCT stable group and the progression group, while the BCVA was stable in the spontaneously improved group. Two factors—a lower severity of myopia and the resolution of vitreoretinal interface traction—were found to be associated with spontaneous anatomic improvement. Two pathways were observed from stage II to stage IV. The more common pathway was progression from stage IIb to IIIb and then to stage IV, but a less common pathway from stage IIa to IIIa directly and finally to stage IV was also observed.
Myopic MS is a degenerative condition in majority cases associated over time with either vision decrease or anatomic deterioration, or both. Our staging system might be useful in providing referral information to find proper indications for surgical intervention and guide the clinical management of this maculopathy.