First Author: Y.Wakatsuki JAPAN
Co Author(s): H. Nakashizuka H. Shimada
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To evaluate the effects of vitrectomy with inverted internal limiting membrane (ILM) flap technique for myopic foveoschisis.
11-17% of surgical myopic foveoschisis cases develop a macular hole postoperatively, and the closure rate of postoperative high myopic macular hole is low. Moreover, patients with postoperative myopic macular holes have poor visual outcomes, and may progress to macular hole retinal detachment.
We studied 18 eyes of 18 patients (5 men, 13 women) with high myopic foveoschisis. Mean age was 64.4 ± 11.2 years. Average axial length was 29.4 ± 1.57mm. We classified myopic foveoschisis into three types based on optical coherence tomography (OCT) findings: retinoschisis type (5 eyes), macular hole type (6), and foveal detachment type (7). The average postoperative follow-up was 11.4 ± 6.2 months. We performed 25 and 27-gauge vitreous surgery in all 18 cases, employing the inverted ILM flap technique, between October 2012 and June 2016. Air tamponade was used in five eyes, SF6 gas in 4, and C3F8 gas in 9. All patients stayed in the face-down position for one full day postoperatively. We analysed visual acuity and foveal contour using OCT before surgery, and at 3 and 6 months postoperatively.
LogMAR visual acuity was 0.56 before surgery, 0.44 at 3 months, and 0.27 at 6 months, showing significant improvement at both 3 and 6 months postoperatively as compared with the preoperative acuities (P = 0.038, 0.00044, the Wilcoxon signed-rank test). On OCT, macular hole closure was achieved in eyes with macular hole type. In eyes with retinoschisis and foveal detachment types, the foveal contours showed improvement without macular hole formation after surgery in all cases.
Vitrectomy, performed using the inverted ILM flap technique, is effective for treating myopic foveoschisis.