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Scleral imbrication is effective for myopic macular schisis

Session Details

Session Title: Vitreoretinal Surgery III

Session Date/Time: Friday 18/09/2015 | 14:30-16:00

Paper Time: 14:46

Venue: Athena

First Author: : T.Baba JAPAN

Co Author(s): :    T. Nizawa   S. Yamamoto           

Abstract Details

PURPOSE:Myopic macular schisis causes macular hole retinal detachment and generally has poor visual prognosis. Scleral imbrication has been reported to be useful to treat refractory retinal detachment cases due to macular hole in highly myopic eyes. We investigated the effectiveness of scleral imbrication combined with pars plana vitrectomy for myopic macular schisis without macular hole.

Setting:

Interventional case series, single institution

Methods:

Nine eyes of 9 consecutive patients with myopic macular schisis without macular hole were included. All cases were followed more than six months. Scleral imbrication was applied using mattress sutures by 6-mm wide, placed at the temporal superior and the temporal inferior quadrant. Pars plana vitrectomy included core vitrectomy and removal of vitreous cortex at the posterior retina. Vitreous cortex was visualized by triamcinolone acetonide. No attempt was made to remove internal limiting membrane. Intraocular gas tamponade was not used. The measurement of best-corrected visual acuity and axial length, and morphological analysis using spectral-domain optical coherence tomography was compared at the baseline and the last visit.

Results:

The mean age of the subject was 67.2 years (range: 61- 76 years). The average follow-up period was 11.4 months (range: 8-18 months). Best-corrected visual acuity improved from 0.74 ± 0.24 to 0.41 ± 0.22 logMAR units (P= 0.008). Axial length shortened from 29.5 ± 1.9 to 28.0 ± 2.4 mm (P= 0.018). In 7 eyes accompanied with macular detachment preoperatively, five eyes (71%) showed complete resolution of subretinal fluid and the rest showed decrease of retinal detachment. Central foveal thickness decreased from 619 ± 286 to 206 ± 123 µm (P= 0.008). No retinal complication including full-thickness macular hole formation was observed.

Conclusions:

Scleral imbrication combined with pars plana vitrectomy was effective to treat macular schisis in eyes with pathologic myopia. Although internal limiting membrane was not removed in any case, retinal detachment was gradually resolved. The correction of globe deformity and the low incidence of intra- and postoperative macular hole formation may explain favorable visual outcome.

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