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Prognostic factor analysis of vitrectomy for myopic foveoschisis
  1. Laurence Shen Lim1,2,3,4,
  2. Wei Yan Ng1,
  3. Doric Wong1,
  4. Edmund Wong1,
  5. Ian Yeo1,
  6. Chong Lye Ang1,
  7. Leo Kim4,
  8. Demetrios Vavvas4,
  9. Shu Yen Lee1,3
  1. 1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  2. 2Department of Ophthalmology, National University of Singapore, Singapore, Singapore
  3. 3Duke-NUS Graduate Medical School
  4. 4Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Shu Yen Lee, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore; lee.shu.yen{at}snec.com.sg

Abstract

Purpose To describe the anatomical and functional outcomes in a cohort of subjects undergoing vitrectomy for myopic foveoschisis, and to analyse the factors predicting foveal reattachment and visual improvement.

Methods This retrospective case series evaluated case records and optical coherence tomography images 6 months after surgery. Multivariate linear and logistic regressions were performed to assess the factors predicting anatomical and visual improvement.

Results In total, 55 eyes of 54 patients were analysed. The mean spherical equivalent refraction was −11.83±4.94D. Foveal detachment was present in 63.5% of eyes preoperatively and subjects with foveal detachment had 0.70 logMAR units (95% CI 0.02 to 1.39) poorer visual acuity than subjects without (p=0.046). The mean preoperative visual acuity was 0.84±0.59 logMAR units and the mean postoperative visual acuity was 0.64±0.64 logMAR units (mean difference 0.20±0.68 logMAR units (p=0.04)). The proportion of eyes with foveal detachment was significantly lower after surgery (12.5%; p<0.001). However, the proportion of eyes with ellipsoid zone disruption was significantly higher after surgery (59.6% vs 34.0%; p<0.001). In multivariate analyses, the preoperative central foveal thickness significantly predicted postoperative visual improvement by two or more lines (OR 1.004 (95% CI 1.000 to 1.007), per μm increase; p=0.049). The presence of ellipsoid zone disruption preoperatively was associated with 0.96 logMAR (95% CI 0.2 to 1.72) poorer final acuity (p=0.02).

Conclusions Eyes with myopic foveoschisis with preoperative ellipsoid disruption and thinner central foveal thickness tend to have poorer visual outcomes. While current surgical manoeuvres are effective in reattaching the fovea, they may also cause iatrogenic injury to the photoreceptors.

  • Posterior Chamber
  • Retina
  • Treatment Surgery
  • Vitreous

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