Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery.
OBJECTIVE
Myopic foveoschisis occurs in 9-34% of highly myopic eyes with posterior staphyloma. The pathogenesis is still not fully understood. But the relative inflexibility of the inner retina and a tangential traction induced inward traction force in the posterior staphyloma are possible mechanisms. Conventional internal limiting membrane (ILM) peeling generally yields good results. However, a postoperative full-thickness macular hole happens in 13-28% of cases. Therefore, this study describes a modified ILM peeling technique named 'ILM maculorrhexis' to minimize the occurrence of postoperative macular hole in patients with foveoschisis.


METHODS
This retrospective case review that included 10 eyes of 10 consecutive patients who underwent vitrectomy with ILM maculorrhexis to treat myopic foveoschisis was studied. After surgery, complete ophthalmic examination and SD-optic coherence tomographic examinations were performed 1, 3, 6, 9 and 12 months postoperatively.


RESULTS
After surgical intervention, the foveoschisis resolved dramatically in all 10 eyes. The mean central foveal thickness decreased significantly from 840 μ to 273 μ at 12 months postoperatively. Mean LogMAR best-corrected visual acuity improved from 1.04 preoperatively to 0.59 12 months postoperatively. After the follow-up time of at least 12 months, all 10 eyes remained fovea attached, and none of the 10 eyes developed macular hole.


CONCLUSIONS
This technique minimizes traction force over the extremely thinned foveal tissue in highly myopic eyes. In the long-term follow-up of at least 12 months, all 10 cases had good anatomic and visual results. But we still need a larger case number and longer follow-up for further evaluation.
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Chia-Ling
CL
Lee
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Wen-Chuan
WC
Wu
Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kuo-Jen
KJ
Chen
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Li-Yi
LY
Chiu
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kwou-Yeung
KY
Wu
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.|Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.|Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Yo-Chen
YC
Chang
D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
foveoschisis; internal limiting membrane; maculorrhexis; spectral-domain OCT