Objective To evaluate the efficacy of vitrectomy with internal limiting membrane（ILM）peeling and perfluoropropane tamponade (C3F8) to treat macular retinoschisis in high myopic eyes.Methods 33 eyes of 31 consecutive high myopia patients with macular retinoschisis were selected randomly; all had posterior staphyloma without retinal detachment. The preoperative refractive errors ranged from －9.5D to －21.0 D with the mean of －(13.1plusmn;3.6) D. The preoperative axial lengths ranged form 26 mm to 32 mm with the mean of (28.3plusmn;2.1) mm. Conventional 20G vitrectomy was performed with ILM peeling and 10% C3F8 infusion, ILM was labeled by Triamcinolone (TA). The best corrected visual acuity (BCVA) and macular structural changes were observed before the surgery, and at 1, 2, 3, 4, 8 months after the surgery. Results Beginning from 1 month after surgery all patients had significant improvement of the macular retinoschisis and BCVA. The macular structure changed very slightly along with the time. The foveal thickness were (327.6plusmn;51.7),(165.2plusmn;22.6),(159.3plusmn;28.7),(167.7plusmn;17.1),(142.7plusmn;13.8) and (169.1plusmn;19.6) mu;m respectively before surgery and 1, 2, 3, 4, 8 months after surgery. The mean foveal thickness was reduced significantly at 18 months followup compared with the preoperational result (t=9.21，9.23，9.21，10.67，9.21; Plt;0.05). The foveal thickness had no significant change at each timepoint after surgery.From 4 months after surgery, recurrence of macular retionoschisis was found in 3 eyes (9.1%).Conclusion Vitrectomy with ILM peeling and C3F8 tamponade is useful to treat macular retinoschisis in high myopic eyes.
The reattachment rate, macular hole (MH) closure rate, visual acuity improvement and re-detachment rate of MH retinal detachment (MHRD) of high myopia are not satisfactory owing to long axis oculi, posterior scleral staphyloma and macular atrophy. At present, minimally invasive vitrectomy surgery combined with the internal limiting membrane flap technique has become popular in the treatment of MHRD, as it can promote MH closure, and significantly improve the outcome of MHRD. However if this method can improve the postoperative visual function is still controversial. The advantage of this technique is that the loosened internal limiting membrane is applied to cover the MH surface to form a scaffold structure similar to the basement membrane. It can stimulate Müller cell gliosis more effectively, and promote tissue filling in the MH which results in MH closure. It can also promote retinal reattachment and reduce the likelihood of retinal re-detachment. This technique is expected to be a standard surgical method for the treatment of MHRD of high myopia in the future. The inserted internal limiting membrane flap technique is relatively easy to perform, induces stable flaps by simple procedures, and can be an essential complement procedure of the inverted internal limiting membrane flap technique. In order to reduce the recurrence rate in the future, it is necessary to further define the indications of different surgical methods and the predictive effects of MH healing mode on the success rate and visual function recovery.
Objective To evaluate the therapeutic effects of vitrectomy with internal limiting membrane (ILM) peeling on retinal detachment in eyes with high myopia. Methods The clinical data of 25 high myopia patients (25 eyes) with retinal detachment and macular hole were retrospectively analyzed. The patients were divided into two groups according to the treatment:13 patients in group A had undergone conventional vitrectomy;12 patients in group B had undergone vitrectomy and ILM peeling.All patients had been tamponaded by inert gas and kept in a facedown position for 7-15 days after the operation. The followup period was 6-18 months (average 10 months).LogMAR visual acuity, ocular fundus, B-scan ultrasonography and optical coherence tomography had been followed up.Results Retinal reattachment was found in 7 eyes (53.8%) in group A and 11 eyes in group B (91.7%), the difference was significant(chi;2=4.427, P=0.046).The macular hole closed in 6 eyes (46.2%) in group A, and 11 eyes (91.7%) in group B; the difference was significant between those two groups (chi;2=5.940，P=0.020). The postoperative visual acuity increased significantly in both groups(Z=-2.045,2.481;P=0.041,0.012), the difference of vision improvement was not significant between those two groups (MannWhitnay U＝51.5，P=0.16). Conclusions By completely releasing the macular traction and increasing retinal flexibility, vitrectomy with ILM peeling can significantly increase the rate of retinal reattachment and closure of macular hole in eyes with high myopia.
Objective To investigate the prevalence of high myopia，the prevalence and risk factors of high myopia associated with chorioretinopathy in residents aged 60 years or over in Beixinjing community, Shanghai, China.Methods A cluster stratified random sampling method was used to screen 4153 people aged 60 and over in Beixinjing community. There were 3851participants in total with a 9273% response rate. Participants were invited to complete a questionnaire and received a comprehensive eye examination including visual acuity, refraction, slitlamp microscopic examination, direct ophthalmoscopy and fundus photography and so on. Spherical equivalent (SE) was used to determine the degree of refractive errors. The diagnosis of high myopic chorioretinopathy was made if SEgt;-6.00 D and myopic chorioretinal atrophy lesions were presented such as posterior scleral staphyloma, lacquer cracks, Fuchs spot and myopic arc spots. The degree of visual acuity impairment was determined according to the World Health Organization (WHO) classification as low vision (the best corrected visual acuity ge; 0.05, but lt;0.3) or blindness (the best corrected visual acuity lt;0.05).Results There were 207/3851(5.37%) high myopia patients, in which 183/207 (88.40%) patients were associated with myopic chorioretinopathy. The prevalence of myopic chorioretinopathy decreased while age increased (chi;2=19.21, Plt;0.01), but statistically there was no gender difference （chi;2=1.83, Pgt;0.05）. Logistic regression analysis showed that there were significant differences in the prevalence of high myopia between people with different age, educational levels and family history （chi;2=19.21，32.08，960.68；Plt;0.01）.There were 29 cases of bilateral blindness, 96 cases of unilateral blindness,104 cases of bilateral low vision and 562 cases of unilateral low vision in those participants. In 183 cases of high myopic chorioretinopathy patients, 111（60.65 %）cases had an obvious visual impairment, including 3448% (10 cases) of bilateral blindness, 1146% (11 cases) of unilateral blindness, 2981% (31 cases)of bilateral low vision and 1050% (59 cases) of unilateral low vision.Conclusions The prevalence of high myopia of residents aged ge;60 years in Beixinjing community, Shanghai,China is relatively high. Age, education level and family history are the most important factors affecting the occurrence of chorioretinopathy in high myopia patients.
Objective To observe the efficacy of pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic macular retinoschisis (MF). Methods This is a retrospective case study. A total of 35 MF patients (36 eyes) were enrolled in this study. There were 5 males (5 eyes) and 30 females (31 eyes), with an average age of (60.13±10.00) years. All patients were examined for best corrected visual acuity (BCVA), diopter, optical coherence tomography (OCT) and axial length. The patients were divided into a MF group (group A, 10 eyes), MF with foveal detachment group (group B, 12 eyes) and MF with lamellar macular hole group (group C, 14 eyes) according to the OCT characteristics. There was no difference of age, gender, spherical equivalent refraction and axial length among 3 groups (F=0.020, 0.624, 0.009, 0.195; P＞0.05). There were significant differences of the minimum resolution angle logarithm (logMAR) BCVA and central fovea thickness (CFT) (F=11.100, 41.790; P＜0.05). All patients underwent pars plana vitrectomy with ILM peeling and gas tamponade. The follow-up was more than one year. The BCVA and macular structure at the final follow-up were analyzed. The efficacy between 3 forms of MF was compared. Results At the final follow-up, the BCVA was 0.40±0.44 and CFT was (213.35±97.58) μm, which were significantly improved compared with preoperative measurements (t=5.984, 5.113; P＜0.001). MF was resolved in 33 eyes. In group A, B and C, the logMAR BCVA were 0.13±0.10, 0.73±0.33 and 0.38±0.52, respectively; CFT was (222.40±57.16), (212.50±150.45), (206.67±55.97) μm, respectively; MF was resolved in 10, 11 and 12 eyes, respectively; complete ellipsoid was observe in 8, 2 and 12 eyes. The logMAR BCVA (F=6.750, P=0.003) and the rate of complete ellipsoid (χ2=18.590, P＜0.001) in group B was lower than group A and C, the differences were significant. There was no difference of CFT (F=0.068, P=0.935) and the rate of MF resolving (χ2=1.558, P=0.459) among the three groups. One eye (1/14) in group C suffered from full layer macular hole. Conclusion Pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic macular retinoschisis. The macular structures and BCVA are worst in eyes with foveal detachment.
Objective To observe the therapeutic effect of combined surgery of anterior and posterior segment and silicon oil tamponade on macular hole retinal detachment in eyes with high myopia.Methods The clinical data of 48 high myopia patients (48 eyes) with macular hole retinal detachment were retrospectively analyzed. Retinal detachment was mainly at the posterior pole; macular hole was confirmed by noncontact Hruby lens and optical coherence tomography (OCT). Phacoemulsification combined with pars plana vitrectomy and silicon oil tamponade were performed to all patients, of which 41 had undergone internal limiting membrane peeling, and 23 had intraocular lens implanting. The oil had been removed 3.5-48.0 months after the first surgery and OCT had been performed before the removal. The followup period after the removal of the silicon oil was more than 1 year.Results The edge of the macular hole could not be seen under the noncontact Hruby lens 1 week after the surgery in all but 5 patients, and the visual acuity improved. The silicon oil had been removed in all of the 48 patients; the OCT scan before the removal showed that the closed macular holes can be in U shape (8 eyes), V shape (6 eyes) or W shape (23 eyes). About 1338 months after the oil removal, retinal detachment recurred in 2 patients with the Wshaped holes. At the end of the followup period, 16 patients (33.3%) had U or Vshaped macular holes, and 32 patients (66.7%) had Wshaped macular holes. The rate of retinal reattachment was 100%.Conclusion Combined surgery of anterior and posterior segment and silicon oil tamponade is effective on macular hole retinal detachment in eyes with high myopia.
Objective To observe the thickness of the retina, retinal nerve fiber layer (RNFL), choroid and sclera among the difference posterior sclera shape (PSS) in high myopia (HM). Methods Sixty HM patients (96 eyes) were enrolled in this study. There were 18 males (25 eyes) and 42 females (71 eyes). The mean age was (51.32±10.06) years. The mean spherical equivalent was (-14.38±6.31) DS. The mean axial length was (29.49±2.44) mm. The eyes were evaluated from deep range imaging optical coherent tomography (DRI-OCT) Atlantis 3D model, and divided as four groups include PSS-Ⅰ (27 eyes), PSS-Ⅱ (46 eyes), PSS-Ⅲ (11 eyes) and PSS-Ⅸ (12 eyes) according to the Curtin classification method. The thickness of the retina, RNFL, choroid and sclera were measured in the EDTRS Grid area. Results There were statistically significant differences in the thickness of retina of the central, first circle, second circle in the EDTRS Grid area among PSS-Ⅰ, PSS-Ⅱ, PSS-Ⅲ and PSS-Ⅸ groups (F=4.48, 5.03, 4.98; P＜0.01). There was no statistically significant differences in the thickness of RNFL among four groups (F=0.13, P=0.93). There was no statistically significant differences in the central choroidal thickness (F=0.31, P=0.81). There were statistically significant differences in the first circle, second circle choroidal thickness among four groups (F=2.86, 2.96; P=0.04, 0.04). There was no statistically significant differences in the thickness of sclera under macular fovea among four groups (F=0.80, P=0.49). Conlusions There are changes of thickness of the retina, choroid present in the difference EDTRS Grid area among the difference PSS in HM, and changes in PSS-Ⅸ is most obvious.
Objective To investigate the distribution of the preferred retinal locus (PRL) of eccentric fixation in eyes with high myopia.Methods A total of 40 highly myopic patients (54 eyes ) with eccentric fixation were examined by MP1 microperimeter to identify the PRL. The position of PRL relative to the fovea was estimated using the 90% confidence ellipse of normal adult foveal fixation. The differences of visual acuity between ldquo;desirablerdquo; and ldquo;undesirablerdquo; PRL were tested by analysis of variance.Results In 54 eyes with high myopia, 24 eyes (44.44%) had PRL of eccentric fixation below the scotoma after loss of central vision; 19 eyes ( 35.19% ) had a leftfield PRL; 6 eyes ( 11.11% ) had an upperfield PRL; and 5 eyes ( 9.26% ) had rightfield PRL. In 14 patients who had binocular eccentric fixation, 13 had the same fixation pattern in both eyes, including lowerfield PRL in 7 （50.00%）, leftfield PRL in 5 （35.71%）, and upperfield PRL in 1 patient （7.14%）. The difference of visual acuity between lower and leftfield PRL group and right and upperfield undesirable PRL group was not statistically significant（F=0.144, Pgt;0.05）. Conclusions The eccentric fixation in eyes with high myopia is usually situated as near as possible to the fovea. The optimal PRL is inferior visual field.
ObjectiveTo objectively quantitative assess the visual quality in patients with myopic foveoschisis (MF) using a double-pass optical quality analysis system (OQASⅡ). MethodsSixty-two subjects participated in this cross-sectional, observational study, who were divided into three groups based on the pathologic conditions including myopic foveoschisis group (MFG), myopic control group (MCG) and normal control group (NCG). Measurements with OQASⅡwere performed for the modulation transfer function cut off frequency (MTF cut-off), the Strehl ratio (SR) and the objective scatter index (OSI). Visual data were analyzed using ANOVA and Pearson's correlation accompanied by logMAR BCVA and axial length (AL). ResultsThe mean values for MTF cut-off, SR and OSI of MFG, MCG and NCG were 18.18±4.81, 0.13±0.03, 3.50±0.44; 22.87±2.66, 0.14±0.02, 2.42±0.29; 33.68±4.70, 0.23±0.02, 1.68±0.20 respectively, and statistical difference were proved except SR between MFG and MCG, or BCVA between MCG and NCG (P < 0.05). LogMAR BCVA and AL have negative correlations to MTF cut-off (r=-0.928, -0.658; P < 0.05) and SR (r=-0.577, -0.893; P < 0.05) with high coefficients in MFG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.659, -0.806; P < 0.05) in MCG. Log MAR BCVA has negative correlations to MTF cut-off and SR (r=-0.606, -0.602; P < 0.05) and positively correlated to OSI (r=0.561, P < 0.05) in NCG. ConclusionsThe mean value of BCVA, MTF cut-off, SR, OSI of myopic foveoschisis patients were lower than those myopic patients without foveoschisis and normal people. there exists a significant negative correlation between Log MAR BCVA, AL to MTF cut-off and SR. Compared with myopic and normal subjects, myopic foveoschisis have lower BCVA, MTF cut-off, SR but higher OSI.