RESUMEN

PURPOSE: To describe the retinal and vitreous changes in eyes showing myopic macular schisis (MMS) improvement when vitrectomy was not performed and identify triggering factors. DESIGN: Retrospective observational study. SUBJECTS: Patients with nonoperated MMS. METHODS: The records of patients with MMS who were followed without performing surgery for >6 months were retrospectively reviewed, and the eyes showing an anatomic improvement were included. Myopic macular schisis evolution was analyzed quantitatively (central foveal thickness [CFT], parafoveal thickness, maximum height) and qualitatively (presence/absence of foveal detachment, lamellar hole, epiretinal membrane, choroidal neovascularization, inner and outer retinoschisis, vitreous status) at baseline and at the final visit. An anatomic improvement was defined as a decrease in CFT by ≥50 µm. MAIN OUTCOME MEASURES: The rate of anatomic improvement of MMS without performing vitrectomy and the morphological changes observed in these cases. RESULTS: In a cohort of 74 nonoperated eyes with MMS, MMS improved in 14 eyes (19%) after a mean follow-up of 55 ± 38 months (range, 8-138). In these improved cases, the mean decrease in CFT was 153 ± 166 µm (range, 24-635; P = 0.005) and a complete resolution of MMS was observed in 9 eyes (64%). In 9 eyes (64%), the improvement was associated with visible vitreous changes in the macular area on the OCT scans. The mean visual acuity, which was already good at baseline (20/50, 0.4 ± 0.2 logarithm of the minimum angle of resolution), increased at the last visit (20/40, 0.3 ± 0.3 logarithm of the minimum angle of resolution) but without reaching significance. CONCLUSIONS: This long-term follow-up analysis showed that almost 20% of MMS in eyes without indication for surgery could improve over time. In most cases, the improvement was associated with an apparent resolution of vitreous tensions. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

RESUMEN

INTRODUCTION: Here we investigate the clinical features of foveal detachment (FD), full-thickness macular hole (MH), and macular hole retinal detachment (MHRD) in myopic traction maculopathy (MTM). METHODS: In the retrospective observational case series, 314 eyes of 198 patients with myopic retinoschisis in Beijing Tongren Hospital were enrolled. We recorded gender, age, and axial length and evaluated fundus characteristics using optical coherence tomography. Epiretinal membranes (ERMs), vitreoretinal traction, and paravascular abnormalities (PVAs) were used to describe the vitreoretinal interface condition. Different retinoschisis layers (inner, middle, and outer retinoschisis) and the location with a range of outer retinoschisis were evaluated to reveal the retinal condition. Five patterns of the scleral shape: dome-shaped, sloped toward the optic nerve, symmetrical or asymmetrical around the fovea, and irregular were assessed to show retina-sclera condition. We regarded the FD, full-thickness MH, and MHRD as the advanced stage in MTM. Multivariate logistic regression assessed significant factors for the advanced stage with odds ratios (OR) and 95% confidence intervals (CI). RESULTS: There were 76 eyes with FD, 6 eyes with full-thickness MH, and 7 eyes with MHRD. The mean age was 52.9 ± 12.3 years. On univariate analysis, the eyes with the advanced stage were older and had higher rates of ERMs, PVAs, middle retinoschisis, outer retinoschisis, and irregular sclera shape. The number of retinoschisis layers and the grade of outer retinoschisis were higher in eyes with the advanced stage. After multivariate logistic regression, ERMs (OR 1.983; 95% CI 1.093-3.595; P = 0.024), middle retinoschisis (OR 2.967; 95% CI 1.630-5.401; P < 0.001), and higher grades of outer retinoschisis (OR 2.227; 95% CI 1.711-2.898; P < 0.001) remained associated with the advanced stage. CONCLUSION: ERMs, middle retinoschisis, and more extensive outer retinoschisis were significant characteristics of the advanced stage in MTM.

RESUMEN

To present a case of anatomical success and visual improvement after the treatment of a long-standing foveal retinal detachment in a staphylomatous myopic eye with foveoschisis and macular hole. A 60-year-old woman with high myopia presented with foveoschisis and a lamellar macular hole in her right eye. After 2 years of follow-up without deterioration, her eye developed a full-thickness macular hole and a foveal retinal detachment which caused a severe reduction in visual acuity. However, the patient had no surgical treatment for her condition at that time. Vitrectomy was performed 2 years after the retinal detachment formation. Regardless of the longstanding detachment, anatomical success, and visual improvement were evident after the surgery. Despite a 2-year longstanding foveal detachment on a highly myopic eye with foveoschisis and macular hole, surgical repair could still be satisfactory.

RESUMEN

BACKGROUND: Peripapillary intrachoroidal cavitation (PICC), a cavernous change in the peripapillary choroid, may present with macular lesions. Here, we present a rare case of PICC with outer lamellar macular hole and macular retinoschisis. CASE PRESENTATION: A 69-year-old man presented with metamorphopsia in the left eye. Fundus examination revealed macular retinoschisis and PICCs. Pars plana vitrectomy with fovea sparing internal limiting membrane peeling (FSIP) was performed. Three weeks postoperatively, the patient developed rhegmatogenous retinal detachment and underwent a second vitrectomy. The macular retinoschisis resolved without macular hole formation and the patient's visual acuity improved. There were no recurrent macular lesions over the three years of postoperative follow-up. Postoperative spectral-domain optical coherence tomography scan revealed a communication between the PICC and the vitreous cavity. CONCLUSIONS: This case shed light on understanding development of PICC in non-highly myopic eyes and a rare complication of macular retinoschisis. Vitrectomy with FSIP may effectively resolve macular retinoschisis.

RESUMEN

BACKGROUND: We evaluated the effect of vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade for myopic foveoschisis (MF), and analysed prognosis with different gas tamponade. METHODS: Retrospective, non-randomized study. The records of patients with MF treated by vitrectomy, were reviewed. Patients were followed up postoperatively mean 16.74 months, to record changes of Best-corrected visual acuity (BCVA) and central foveal thickness (CFT). RESULTS: Sixty-two eyes (59 patients) were analysed in total, with mean age of 55.29 ± 10.34 years, 49 females (83.1%). Foveoschisis completely resolved in all eyes at least 6 months post vitrectomy, except for two postoperative full-thickness macular holes (FTMH). Final BCVA improved significantly from 0.69 ± 0.39 to 0.44 ± 0.42 logMAR, and CFT from 502.47 ± 164.78 to 132.67 ± 52.26 µm. Patients were subdivided into three subgroups based on the different endotamponades used (C3F8, C2F6, and air). Baseline BCVA, baseline CFT and foveal detachment (FD) were not significantly different among the three groups. Eyes treated with air tamponade had better visual outcomes than eyes with C3F8 tamponade (P = 0.008). Baseline BCVA and FD were significant risk factors for postoperative BCVA (P < 0.001 and P = 0.013, respectively). CONCLUSIONS: Vitrectomy with ILM peeling and gas tamponade results in good functional and anatomic outcomes in the treatment of most MF. Good vision and no-FD pre-surgery are related with good visual prognosis. Air tamponade can provide as good visual recovery as expansive gas, and reduce postoperative complications.

Asunto(s)

RESUMEN

BACKGROUND: To investigate the long-term surgical outcomes and prognostic factors of foveal detachment (FD) in pathological myopia. METHODS: This retrospective observational study included 59 patients with FD (61 eyes) who underwent pars plana vitrectomy at Shanghai General Hospital between June 2017 and July 2018 with follow-up for at least 24 months. Comprehensive ophthalmic examinations, including best-corrected visual acuity (BCVA) and swept-source optical coherence tomography, were assessed. Preoperative myopic maculopathy was evaluated according to the ATN classification. RESULTS: FD completely resolved in 59 of 61 eyes (96.7%). Mean duration of retinal reattachment was 12.10 ± 8.10 months. Mean logMAR BCVA improved from 1.34 ± 0.52 to 0.83 ± 0.43 at 24 months postoperatively (P < 0.001). Secondary macular hole occurred in 8 eyes (13.1%) with a mean period of 3.4 ± 4.1 weeks after primary surgery. In regression analyses, baseline myopic atrophy maculopathy (MAM) (B = 0.213, P = 0.005) and vitreomacular traction (VMT) (B = 0.292, P = 0.007) were adverse prognostic factors for postoperative BCVA. A more severe MAM revealed a delay in retinal reattachment (B = 5.670, P = 0.002). FD eyes with VMT (OR = 1.309, P = 0.003) or outer lamellar macular hole (O-LMH) (OR = 1.369, P < 0.001) were risk factors for postoperative secondary macular hole. CONCLUSIONS: Vitrectomy was effective in the long-term for treating FD. Careful consideration is needed for those with VMT or O-LMH due to the high risk of secondary macular hole after vitrectomy. FD eyes with more severe MAM tended to have poorer postoperative BCVA and extended periods of retinal reattachment.

Asunto(s)

RESUMEN

PURPOSE: To describe myopic nontractional foveal detachment associated with pachychoroid diseases. METHODS: This retrospective study included 15 myopic eyes which had nontractional serous foveal detachment. The eyes were divided into myopic central serous chorioretinopathy (CSC) group (n = 8) and a myopic pachychoroid neovascularization (PNV) group (n = 7) according to the presence of type 1 choroidal neovascularization on multimodal imaging. The findings of multimodal imaging and treatment response were described. RESULTS: In myopic CSC group, pachychoroid features such as pachyvessels, choroidal vascular hyperpermeability and punctate hyperfluorescent spots were noted in 8 eyes (100%), 8 eyes (100%), 5 eyes (62.5%) respectively. The above features were noted in 7 eyes (100%), 5 eyes (83.3%), 5 eyes (83.3%), respectively, in the myopic PNV group. Five of 8 eyes in myopic CSC and all 7 eyes received treatment including anti-vascular endothelial growth factor injection and/or photodynamic therapy. However, only five eyes had a complete response. CONCLUSIONS: The pachychoroid phenotype may coexist with high myopia and lead to myopic nontractional serous foveal detachment. Our series suggest that the response to treatment for these conditions would be limited.

Asunto(s)

RESUMEN

A pseudophakic female patient, 80 years of age, presented with a vitreomacular traction and foveal detachment at her right eye. To avoid development of a full-thickness macular hole during surgery, foveal-sparing ILM peeling was performed. After surgery, distance-corrected visual acuity increased from 0.3 to 0.6 (Snellen) 3 months after surgery and fovea was re-attached again with restoration of the retinal layers.

RESUMEN

PURPOSE: To compare the outcomes of macular buckling (MB) surgery between myopic foveal detachment (FD) eyes with and without ellipsoid zone (EZ) disruption. METHODS: A retrospective, case-control study. Forty-four consecutive eyes from 44 patients received MB surgery for myopic FD between November 2017 and January 2019 were included. The eyes were divided into two groups according to the integrity of EZ on spectral-domain optical coherence tomography (SD-OCT): 28 eyes with disrupted EZ band and 16 eyes with intact EZ band. Main outcome measures were visual acuity and the duration of subfoveal fluid (SFF) after MB. RESULTS: The mean follow-up time was 17.64 ± 6.61 and 16.06 ± 5.78 months in the disrupted EZ and intact EZ group, respectively (P = 0.430). The logMAR best-corrected visual acuity (BCVA) improved significantly, from 1.13 ± 0.46 and 1.12 ± 0.39 at baseline to 0.85 ± 0.65 (P = 0.002) and 0.53 ± 0.33 (P = 0.000) for the disrupted EZ group and intact EZ group, respectively. The mean visual improvement was 15.00 ± 14.14 Early Treatment Diabetic Retinopathy Study (ETDRS) letters for the disrupted EZ group and 26.88 ± 19.48 ETDRS letters for the intact EZ group. Significant difference was found on both final postoperative BCVA (P = 0.035) and visual improvement (P = 0.025). At 6 months, SFF remained in 53.57% (15/28) of the eyes in the disrupted EZ group and in only 12.50% (2/16) of the eyes in the intact EZ group (P = 0.018). CONCLUSION: The intact EZ group showed better functional and anatomical outcomes than the disrupted EZ group after MB surgery.

Asunto(s)

RESUMEN

PURPOSE: To determine the efficacy of displacing a prepapillary membrane during vitrectomy assisted by intraoperative optical coherence tomography (OCT) to treat eyes with optic disc pit maculopathy. METHOD: Pars plana vitrectomy was performed with 27-gauge instruments on 4 eyes of 4 consecutive patients for optic disc pit maculopathy with retinoschisis and foveal detachment. After creating a posterior vitreous detachment, the prepapillary membrane was made visible by brilliant blue G staining. The membrane was peeled from the central retinal vessel and inverted and placed over intraretinal clefts or stuffed into the optic disc pit. These procedures were guided by intraoperative OCT. A gas tamponade and peripapillary laser was not used. The preoperative and postoperative OCT images and surgical outcomes were evaluated. RESULT: Intraretinal clefts connected to an inner retinoschisis were detected at the edge of the optic disc pit in 3 eyes with intraoperative OCT and 2 eyes with preoperative OCT. The foveal detachment and retinoschisis were resolved completely in all 4 eyes at postoperative 13 to 15 months. The postoperative vision improved from 20/25 to 20/18 at the final examination in all eyes. CONCLUSION: Intraoperative OCT can detect intraretinal clefts at the edge of the optic disc pit, and the OCT images are helpful in guiding the peeling and placement of the prepapillary membrane to achieve anatomical and visual recovery.

Asunto(s)

RESUMEN

PURPOSE: We report the clinical courses of two patients with papillomacular retinoschisis in eyes with advanced glaucomatous optic neuropathy. OBSERVATIONS: In case 1, a 67-year-old woman was diagnosed with papillomacular retinoschisis and normal tension glaucoma in the left eye. Her medication was switched from topical latanoprost to brinzolamide, resulting in gradual improvement in the papillomacular retinoschisis thereafter. In case 2, a 76-year-old man was diagnosed with papillomacular retinoschisis, foveal detachment, and normal tension glaucoma in the left eye. His medication was switched from topical tafluprost/timolol to brinzolamide, resulting in gradual improvement in the papillomacular retinoschisis and foveal detachment thereafter. CONCLUSIONSAND IMPORTANCE: Papillomacular retinoschisis may occur in eyes with advanced glaucomatous optic neuropathy. Topical brinzolamide therapy may lead to improvement of papillomacular retinoschisis.

RESUMEN

BACKGROUND: Internal limiting membrane (ILM) drape sign is an important OCT characteristic of Macular telangiectasia type 2 (MacTel 2). Described here is a case where masking of the ILM drape sign occurred with bilateral foveal detachments in a patient with MacTel 2. CASE PRESENTATION: A 64-year old female was diagnosed with MacTel 2, four years prior to the current presentation on the basis of an OCT demonstrating bilateral ILM drape sign. Fluorescein angiography showed bilateral dilated, ectatic capillaries and late phase dye leak. At the current presentation there was bilateral gradual visual impairment over two months due to bilateral foveal detachments. Treatment with intravitreal Bevacizumab resulted in unmasking of the pre-existing ILM drape sign at 12 weeks. Visual acuity was reduced to counting fingers in the left eye with the neovascular membrane as a consequence of sub-retinal fibrosis, while the right eye maintained a vision of 6/12. A difference in the stage of the disease at presentation determined the long-term visual outcome after seven years of observation. CONCLUSION: Foveal detachment can influence the OCT detectability of pre-existing foveal cystoid lesions. Visual prognosis at the final follow up was consistent with the interocular disparity of the disease stage at presentation.

Asunto(s)

RESUMEN

Myopic foveoschisis (MF) is common in highly myopic eyes with posterior staphyloma, and optical coherence tomography is essential for establishing the diagnosis and monitoring disease progression. Untreated MF may lead to significant visual loss due to secondary complications. Vitrectomy with or without internal limiting membrane peeling followed by gas tamponade is the standard treatment; however, in recent years, new techniques, including macular buckling, have been introduced. We selected a total of 41 articles with 30 describing various modifications of pars plana vitrectomy, six describing the macular buckling technique, and five reporting combined surgery. The present review describes current MF treatment strategies, including outcomes, and provides a comprehensive understanding of current therapeutic options. Early detection and surgical intervention in eyes with specific risk factors may contribute to both improved visual recovery and more favorable anatomical outcomes.

Asunto(s)

RESUMEN

AIM: To study anatomical and visual outcomes of pars plana vitrectomy (PPV) with non-fovea-sparing (entire) internal limiting membrane (ILM) peeling in eyes with myopic foveoschisis (MF). METHODS: Prospective interventional case series of eyes undergoing PPV with entire ILM peeling for symptomatic MF. MAIN OUTCOME MEASURES: Preoperative spectral domain optical coherence tomography (SD-OCT) epiretinal membrane, anomalous posterior vitreous detachment, vitreoschisis and postoperative changes in SD-OCT central foveal thickness (CFT), ellipsoid zone defect, foveal detachment (FD), macular hole (MH) diameter (if present) and best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR). RESULTS: This study included 21 eyes (21 patients) with mean age 60.4±13.1, 15 females (71.4%). All patients achieved complete postoperative reattachment by SD-OCT (no FD) 6 months post vitrectomy, with no iatrogenic intraoperative or postoperative MH, and with significant improvement in final BCVA from 1.6±0.30 to1.0±0.2 logMAR, and in CFT from 918.2±311.4 to182.3±33.1 µm. Patients were subdivided into subgroup A: 11 eyes without MH; and subgroup B: 10 eyes with MH, the latter had significant improvement in MH diameter (p=0.005). Preoperative BCVA was a significant risk factor for visual gain, while preoperative FD and CFT were significant for CFT change. CONCLUSION: Vitrectomy with non-fovea-sparing (entire) ILM peeling resulted in a significant functional and anatomical improvement in eyes with MF with/without MH with no reported complications. Results are comparable to fovea-sparing ILM peeling.

Asunto(s)

RESUMEN

BACKGROUND: To report a case of complete progressive visual recovery and healing of outer retinal layers after vitrectomy for foveal detachment associated with optic disc pit. CASE PRESENTATION: Optical coherence tomography (OCT) follow-up was performed on a 15-year-old boy with deep optic disc pit and foveal detachment, before and for 10 years after vitrectomy with gas. The foveal detachment was successfully reattached with complete reapplication of the retina. OCT scans showed a progressive long-term retinal healing with reappearance of the ellipsoid line and visual acuity improved from 20/100 before surgery to 20/25, 10 years after surgery. CONCLUSIONS: Photoreceptor regeneration after foveal detachment surgery has been already described only in zebrafish but never humans. However, we highlight with this case that in humans, a healing process of the outer retinal layers can occur with reappearance of the ellipsoid zone on OCT. This healing process may take several years and allow a complete functional restoration.

Asunto(s)

RESUMEN

Dome-shaped macula (DSM) was first described by Gaucher et al. as a convex protrusion of macula within a staphyloma in highly myopic eyes that cause visual impairment associated with serous foveal detachment (SFD). We describe a patient with persistent SFD in DSM documented by serial spectral domain optical coherence tomography for 7 years with stable vision.

Asunto(s)

RESUMEN

PURPOSE: To evaluate the therapeutic efficacy of a novel surgical procedure for diffuse diabetic macular edema (DME), performed in conjunction with conventional vitrectomy. METHODS: This prospective, interventional case series involved 20 eyes of 18 consecutive DME patients with best-corrected visual acuities (BCVAs) between 0.301 and 1.221 logarithm of the minimal angle of resolution (logMAR) units and central retinal thicknesses (CRTs) greater than 275 µm. After vitrectomy, a small retinal detachment was made in the macula by injecting 50-100 µl balanced salt solution into the subretinal space using a 38-gauge needle. Before finishing the surgery, fluid-air exchange was performed. Patients were asked to remain in prone position for 1 day postoperatively. The main outcome measures were CRT and BCVA. RESULTS: The mean CRT of 554.6 ± 152.7 µm before surgery significantly decreased to 295.6 ± 92.5 µm (p < 0.0001) 1 week after surgery and to 185.8 ± 67.4 µm (p < 0.0001) at 6 months after surgery. The CRT was less than 250 µm in 18 eyes (90 %) at 6 months after surgery. The mean BCVA before surgery (0.706 ± 0.348) significantly improved at 6 months after surgery (0.431 ± 0.392, p < 0.0001). Postoperative BCVAs improved by more than 0.3 logMAR units in 13 eyes (65 %), remained unchanged in six eyes (30 %) and worsened in one eye (5 %). Macular edema recurred in three eyes (15 %) 2 months after surgery. CONCLUSIONS: This novel planned foveal detachment technique facilitated a rapid resolution of DME and contributed to improved visual acuity.

Asunto(s)

RESUMEN

Dome-shaped macula (DSM) was recently described in myopic patients as a convex protrusion of the macula within a posterior pole staphyloma. The pathogenesis of DSM and the development of associated serous foveal detachment (SFD) remain unclear. The obstruction of choroidal outflow and compressive changes of choroidal capillaries have been proposed as causative factors. In this paper, we report two cases of patients with chronic SFD associated with DSM treated with oral spironolactone. After treatment, there was a complete resolution of SFD in both patients. To the best of our knowledge, this is the first report of successful treatment of SFD in DSM by a mineralocorticoid receptor antagonist.

RESUMEN

PURPOSE: To describe the evolution of a full-thickness macular hole in myopic foveoschisis. METHODS: A 62-year-old woman with myopic foveoschisis developed a full-thickness maculare hole after 36 months. The evolution of the macular hole was observed by optical coherence tomography (Stratus OCT3). RESULTS: During the first stages of macular hole formation, a small triangular foveolar retinal detachment, with corresponding elevation of inner segment/outer segment junction line, was observed. The retinal detachment later enlarged. A concrete intraretinal columnar structure, extending between the inner fovea's layer and the roof of foveal detachment, was observed. CONCLUSION: The so-called columnar structure, detected in our case, possibly transmitted the vitreomacular traction contributing to the opening of the RD roof, the outer lamellar macular hole formation, and finally in the creation of a full-thickness macular hole.

Asunto(s)

RESUMEN

Objective To describe the morphological characteristics of foveal retinoschisis and retinal detachment in highly myopic eyes. Design Retrospective observational case series. Participants Twenty-nine patients (38 eyes) of high myopia with foveal retinoschisis and retinal detachment. Methods All patients with foveal retinoschisis and retinal detachment were performed complete ophthalmic examinations, B-scan and studied cross-sectional images of the maculae with optical coherence tomography (OCT). 10 eyes underwent vitreous surgery. Main Outcome Measures Morphological characteristics. Results On biomicroscopy, the maculae of all 38 eyes had a microcystic appearance and shallow elevation without macular hole. B-scan showed posterior retinal edema or with 0.5 to 2mm detachment. OCT disclosed foveal retinoschisis and retinal detachment in all eyes. The neuroretina splitted into a thick inner layer and a thin outer layer or a thin inner layer and a thick outer layer or a thin inner layer, a thick inter layer and a thin outer layer. A hyperreflective preretinal structure resembling the posterior hyaloid was stretched over the retinoschisis and drew the retina. Vitreous surgery performed on 10 eyes, including posterior vitreous detachment, removal of the premacular vitreous cortex. In all eyes, foveal detachment and retinoschisis gradually decreased in height, and attained foveal attachment finally. Conclusion Foveal retinoschisis and retinal detachment in highly myopic eyes with staphyloma is better characterized with OCT than with biomicroscopy. Vitreomacular traction forms the posterior hyaloid and the staphyloma maybe the major cause of it.