Surgical outcomes of macular buckling techniques for macular retinoschisis in highly myopic eyes

Purpose

To report the anatomic and visual results following macular buckling for patients with macular retinoschisis related to high myopia.

Methods

Thirty-nine highly myopic eyes (mean refractive error −16.7 D; range, −9 to −24 D) of 36 patients (mean age 59 years; range, 35–79 years) presenting with macular retinoschisis associated with a posterior staphyloma, who underwent combined vitrectomy and macular buckling were evaluated. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) findings. Three cases were excluded due to short follow-up (less than 3 months). The mean follow-up was 16 months.

Results

The mean BCVA increased from 0.76 to 0.43 LogMAR (p = 0.001). Visual acuity improved in 30 eyes (83.3%), remained stable in three eyes (8.3%) and decreased in three eyes (8.3%). OCT showed resolution of foveoschisis with foveal reattachment in all eyes. None of the evaluated patients developed a macular hole during follow-up.

Conclusion

Macular buckling associated with vitrectomy results in good anatomic and visual outcomes in patients with myopic foveoschisis.     

Early macular holes with retinoschisis in highly myopic eyes

PURPOSE: We present two cases with early macular holes (MH) complicated by retinoschisis and foveal detachment (RSFD). DESIGN: Case reports. CASE REPORT: A 46-year-old woman and a 70-year-old woman, both with high myopia, presented visual loss and a small MH associated with RSFD. Vitrectomy and gas tamponade were performed. However, both MHs enlarged postoperatively, resulting in progressive retinal detachment. Additional gas tamponade led to retinal reattachment. At the final visit, the MH was open in case 1 but closed in case 2. CONCLUSIONS: Although the benefit of vitrectomy is uncertain, RSFD and MHs can be associated in highly myopic eyes.     

Internal limiting membrane removal for macular detachment in highly myopic eyes

PURPOSE: To present a treatment option for highly myopic eyes developing retinal detachment over a posterior staphyloma. DESIGN: Interventional case report. METHODS: Pars plana vitrectomy with peeling of the internal limiting membrane and gas tamponade; no laser retinopexy. RESULTS: Retinal reattachment with marked visual improvement. CONCLUSIONS: It appears that the rigid internal limiting membrane is responsible for the retina's inability to conform to the posterior staphyloma. Intraoperative findings suggest that this rigidity may also play a role in subsequent macular hole development. Internal limiting membrane removal should be considered in eyes with retinal detachment over a posterior staphyloma, whether or not a macular hole is present.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

高度近视黄斑部视网膜劈裂和非裂孔性视网膜脱离

目的 观察高度近视黄斑部视网膜劈裂(MRS)和非裂孔性视网膜脱离(MRDH)的临床表现和影像学特征.方法 高度近视患者186例349只眼中合并MRS和MRDH的19例24只眼纳入研究.所有患者均进行了主觉验光、双目间接检眼镜、裂隙灯显微镜联合Goldmann三面镜检查,以及眼底照相、A/B型超声和光相干断层扫描(OCT)检查.结果 349只眼中后极部存在MRS和(或)MRDH 24只眼,占6.9%.眼底检查结果 显示.所有患跟均有后巩膜葡萄肿(PS),占100.0%;玻璃体黄斑牵引条带(VMT)2只眼.占8.3%;黄斑部局限性视网膜浅脱离2只眼,占8.3%;黄斑全层裂孔1只眼,占4.2%.B型超声检查结果 显示,所有患眼均伴有PS,占100.0%;黄斑部局限性视网膜浅脱离7只眼,占29.2%,脱离的视网膜与PS锥顶形成弓样结构;VMT条带2只眼,占8.3%.OCT检查结果 显示,黄斑部外层视网膜劈裂(ORS)22只眼,占91.7%,其中合并黄斑部内层视网膜劈裂(IRS)8只眼,占黄斑部ORS的36.4%.MRDH 5只眼,占20.8%,其中合并ORS 3只眼,占MRDH的60.0%;单纯性MRDH 2只眼,占MRDH的40.0%,其中合并VMT 1只眼.VMT 13只眼,占54.2%;黄斑囊样水肿(CME)3只眼,占12.5%;黄斑板层裂孔4只眼,占16.7%.结论 MRS和MRDH是伴有PS的高度近视眼的常见并发症.与常规眼底检查和B型超声相比,OCT是发现MRS和MRDH的更为有效的检查手段.     

Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment

PURPOSE: To investigate the natural course of macular retinoschisis in highly myopic patients. DESIGN: A prospective, observational case series. METHODS: Seven consecutive patients (eight eyes) with macular retinoschisis without macular hole or retinal detachment determined by optical coherence tomography (OCT) were followed at least two years without surgical intervention. The changes in the OCT findings and best-corrected visual acuity (BCVA) were analyzed. RESULTS: During follow-up, two eyes that had vitreoretinal adhesions developed a macular hole, one with and one without retinal detachment (RD), and two eyes without detectable vitreoretinal adhesion developed RD without a macular hole. BCVA in these four eyes was significantly reduced. The remaining four eyes did not develop complications, although the thickness of the macula increased significantly. CONCLUSIONS: These findings suggest that macular retinoschisis might be a progressive condition, and that complications appeared to be related to the presence of vitreoretinal tractions.     

高度近视眼黄斑裂孔性视网膜脱离的治疗

目的:探讨玻璃体手术治疗高度近视眼黄斑裂孔引起的视网膜脱离的疗效。方法:回顾性分析2001-03/2007-02的1组病例31例(32眼)。纳入标准为屈光不正≥-6.00D,黄斑下视网膜脉络膜萎缩的白色黄斑裂孔引起的原发性视网膜脱离,经过玻璃体手术联合硅油填充术治疗的病例,随访时间≥6mo。结果:随访时间6～12(平均8.4)mo。所有病例均行玻璃体切除联合硅油填充术、自体浓缩血小板封黄斑裂孔。8眼进行了内界膜剥除。术后最终视网膜复位29眼(91%),未复位3眼;术后视力提高22眼(69%),不变7眼(22%),下降3眼(9%)。结论:玻璃体切除术,自体浓缩血小板封孔是治疗高度近视眼黄斑裂孔性视网膜脱离的一种有效方法。     

高度近视黄斑区玻璃体视网膜界面异常手术治疗中值得探讨的几个问题

高度近视黄斑劈裂、黄斑裂孔等黄斑区玻璃体视网膜界面异常严重影响高度近视患者的视功能,其自然病程各异,手术治疗的关键是如何去除玻璃体后皮质对黄斑区视网膜的牵引,恢复黄斑中心凹原有的解剖结构,保持和(或)提高中心视功能.但玻璃体腔注气、后巩膜兜带和(或)加固、玻璃体切割手术等具体干预方式的选择和应用仍存在许多争议并值得探讨.如何正确理解和评价现有这些风格迥异的手术方式及其疗效,根据疾病的不同特点制定治疗方案是目前急需解决的现实问题.     

The development and evolution of full thickness macular hole in highly myopic eyes

Purpose

To evaluate the morphological changes before and after the formation of a full-thickness macular hole (MH) in highly myopic eyes.

Patients and methods

Retrospective observational case series. From 2006 to 2013, clinical records of patients with MH and high myopia who had optical coherence tomography (OCT) before the development of MH were reviewed. All patients had been followed for more than 1 year since MH formation to observe the morphological changes.

Results

Twenty-six eyes of 24 patients were enrolled. The initial OCT images could be classified into four types: (1) normal foveal depression with abnormal vitreo-retinal relationship (eight cases), (2) macular schisis without detachment (six cases), (3) macular schisis with concomitant/subsequent detachment (nine cases), and (4) macular atrophy with underlying/adjacent scar (three cases). After MH formation, one case in type 1 and one case in type 4 group developed retinal detachment (RD). In type 2 group, four cases developed RD at the same time of MH formation. The preexisting detachment in type 3 group extended in eight cases and improved in one case. Among all the cases, 14 eyes received vitrectomy and 7 eyes received gas injection. MH sealed in nine eyes after vitrectomy and four eyes by gas injection.

Conclusion

The study revealed four pathways of MH formation in highly myopic eyes. MH from macular schisis tended to be associated with detachment. However, the evolution and the results of surgical intervention were not always predictable.     

Retinal detachment in highly myopic eyes due to macular holes and epiretinal traction

We operated on four highly myopic eyes with recurrent retinal detachment due to macular holes. A thin layer of epiretinal tissue was present over the posterior retina in each eye, probably causing tangential traction on the retina and accounting for the recurrent detachment. Biopsy of the tissue from one case showed mainly acellular material resembling cortical vitreous. Recognizing this clinical condition may permit successful treatment of certain cases with recurrent retinal detachment in highly myopic eyes with macular holes.     

Retinal detachment due to macular holes in highly myopic eyes. Prognostic factors

PURPOSE: To evaluate the prognostic value of axial length and epiretinal membrane (ERM) separation during vitrectomy for retinal detachment due to macular hole in high myopia. PATIENTS AND METHODS: Thirty-two consecutive highly myopic eyes (31 patients) with retinal detachment due to a macular hole were retrospectivly studied. All eyes underwent pars plana vitrectomy with gas tamponade (C3F8). An epiretinal membrane was removed in 9 cases. The 32 cases were divided into 3 groups: anatomical success after the initial surgery (group 1, 15 cases); anatomical success after two surgical procedures without silicone oil (group 2, 5 cases), and silicone oil tamponade (group 3, 12 cases). RESULTS: Retinal reattachment occurred in 15 cases (46.8%) after the initial surgery. The difference of axial length between the 3 groups was not significant. The rate of anatomical success without silicone oil was 88.8% (8/9 cases) when an ERM was peeled and the number of peelings was significantly higher (p=0,04) in group 1 than in group 3. CONCLUSION: The axial length was not a pronostic factor of silicone oil tamponade in this study. The success rate was higher when an ERM was peeled. However, considering the technical difficulty in removing the ERM completely, gas tamponade seems to be the better initial treatment.     

高度近视眼黄斑劈裂的OCT影像特征

目的 观察高度近视眼黄斑劈裂的OCT形态学特征,分析其发生的相关危险因素.方法 回顾性分析268例(369只眼)屈光度≥-6.00D的高度近视眼患者继发视网膜劈裂的OCT表现以及与眼轴长度、屈光度、后巩膜葡萄肿、后极部脉络膜视网膜萎缩变性等因素的相互关系.结果 OCT显示68例(93只眼)存在视网膜劈裂;其中78只眼为外层劈裂,14只眼为混合性劈裂,1眼为内层劈裂.所有存在劈裂眼中,2只眼劈裂远离黄斑区,91只眼位于黄斑区,累及一至四个象限不等,其中53只眼为中央凹劈裂,38只眼为旁中央凹劈裂,中央凹劈裂的形态多样,并伴有视网膜前膜或玻璃体牵引、局限性视网膜脱离、黄斑板层裂孔等改变.所有高度近视眼患者中,视网膜劈裂眼与未发生视网膜劈裂眼的眼轴长度、屈光度、后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性比较,差异均有统计学意义(P均<0.01),Logistic回归结果示:超长眼轴(≥29mm)是视网膜劈裂发生的危险因素,屈光度并不是其发生的危险因素,后巩膜葡萄肿、玻璃体牵引或视网膜前膜以及后极部脉络膜视网膜萎缩变性均是其发生的危险因素(P=0.002,0.073,0.027,0.003,0.011).结论 OCT能明确视网膜劈裂发生的部位,清晰地显示视网膜劈裂的形态特征,视网膜劈裂多发生在黄斑中央凹.可累及整个黄斑区,以外层劈裂多见.视网膜劈裂的发生与超长眼轴、后巩膜葡萄肿、玻璃体视网膜牵引以及后极部脉络膜视网膜萎缩变性等因素有关.

Abstract：

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

高度近视眼黄斑劈裂的OCT影像特征

Objective To improve our understanding of the morphological characteristics of macular retinoschisis in highly myopic eyes by optical coherence tomography and to discuss the probably associated factors of it. Methods In the retrospective study, 268 patients(369 eyes)with high myopia(spherical equivalent 3≥-6.00D)were included, from which a diagnosis of retinoschisis was given by optical coherence tomography, and observed the area and morphological characteristics of the retinoschisis. The factors that were associated with the occurrence and the development of the retinoschisis were investigated. Results OCT showed that 68 patients(93 eyes)had retinoschisis. Outer schisis was present in 78 eyes, mixed schisis in 14 eyes and inner schisis in 1 eye. The retinoschisis in 2 eyes located far from the macular area, and the other 91 eyes located in the macular area, which were involved into one to four quadrants, in which foveoschisis were present in 53 eyes, and parafoveoschisis in 38 eyes. There were several kinds of types in foveoschisis, companied with other pathological changes, such as vitreoretinal traction, preretinal membrane, foveal detachment and lamellar holes.We proceeded the comparison of the axial length, spherical equivalent, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy in retinoschisis and non-retinoschisis in highly myopic eyes, finding that all the differences were significant(P <0.01), but Logistic regression showed that all the factors above were the risk factors associated with the retinoschisis(P =0.002, 0.027, 0.003, 0.011)except the spherical equivalent(P =0.073). Conclusions OCT can display the area and morphological characteristics of retinoschisis clearly, the retinoschisis is mostly present in the fovea, which is usually involved into the whole macular area, and the outer schisis is common. The occurrence and development of the retinoschisis is associated with the axial length, posterior staphyloma, vitreoretinal interface factors and posterior polar chorioretinal atrophy.     

Surgical management of retinal detachment in highly myopic eyes with macular hole.

BACKGROUND AND OBJECTIVES: To evaluate the visual and anatomical outcomes of surgery for retinal detachment due to macular hole in highly myopic eyes with pronounced posterior staphyloma. PATIENTS AND METHODS: Data for all patients with high myopia who underwent surgery for retinal detachment resulting from macular hole from 1993 to 2002 in one hospital were evaluated. Patient characteristics, best-corrected visual acuity preoperatively and at last examination, surgical technique, anatomical success, and follow-up period were extracted and analyzed statistically. RESULTS: Twenty-six of the 27 patients (28 eyes) were female (96%) with a mean age of 59.8 years; mean follow-up was 17.3 months. Mean axial length was 29.1+/-2.74 mm; mean myopia was -16.4 +/- 3.1 diopters. Marked posterior staphyloma was detected in 71%. Seven eyes had undergone failed scleral buckling as the primary procedure; intravitreal SF6 injection was the primary procedure in 12 eyes. Twenty-three eyes underwent deep vitrectomy with use of high viscosity silicone oil. Overall anatomical success was achieved in 92.9% (26 of 28 eyes); 78.6% had visual improvement. CONCLUSIONS: Vitreous surgery combined with other necessary adjunct procedures such as membrane peeling and use of retinal tamponade, as a primary or a secondary procedure, seems to be successful in achieving retinal reattachment in eyes with macular hole and posterior staphyloma.     

Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes

PURPOSE: To report anatomic and visual improvement following vitrectomy with internal limiting membrane (ILM) peeling for two highly myopic patients with retinoschisis and/or retinal detachment without a macular hole. DESIGN: Two interventional case reports. METHODS: Two highly myopic patients who had retinoschisis and/or retinal detachment without a full-thickness macular hole underwent vitrectomy, internal limiting membrane peeling, and long-acting gas injection. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and optical coherent tomography finding. RESULTS: Vitrectomy with ILM peeling results in biomicroscopic, functional, and tomographic improvement in both patients, for follow-up periods of 12 months and 8 months, respectively.CONCLUSIONS: Vitrectomy with ILM peeling and gas tamponade is an effective method for retinoschisis and/or retinal detachment without a macular hole in highly myopic patients.