Elsevier

Ophthalmology

Volume 110, Issue 9, September 2003, Pages 1702-1707
Ophthalmology

Original article
Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis1,

https://doi.org/10.1016/S0161-6420(03)00714-0Get rights and content

Abstract

Purpose

To evaluate the efficacy of vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis.

Design

Retrospective comparative interventional case series.

Participants

Seven patients (nine highly myopic eyes) with posterior staphyloma with foveal detachment and retinoschisis without macular hole. Preoperative best-corrected visual acuity in nine eyes ranged from 0.02 to 0.4 (average, 0.17).

Methods

Vitreous surgery performed on all nine eyes consisted of core vitrectomy, surgically induced posterior vitreous detachment (three eyes), removal of the premacular vitreous cortex and internal limiting membrane in the posterior staphyloma, and 30% SF6 gas tamponade. Patients were instructed to maintain a prone position for at least 1 day after surgery. The postoperative follow-up period ranged from 6 to 42.5 months (average, 20.4 months).

Main outcome measures

Visual acuity, retinal tomography monitored by optical coherence tomography.

Results

In eight of the nine eyes, foveal detachment and retinoschisis gradually decreased in height, and these eyes finally attained foveal attachment and visual improvement within 6 months postoperatively. The postoperative best-corrected visual acuity of these eight eyes ranged from 0.4 to 0.6 (average, 0.48). One eye developed a full-thickness macular hole during vitreous surgery, and its postoperative best-corrected visual acuity was 0.08.

Conclusions

Foveal detachment and retinoschisis in highly myopic eyes resolved after vitrectomy. Vitreous surgery might have a rationale as prophylactic treatment for highly myopic eyes at high risk of macular hole development.

Section snippets

Patients and methods

In a prospective study of nine highly myopic eyes with posterior staphyloma in seven consecutive patients (five women and two men), we performed vitreous surgery at Gunma University Hospital between May 1999 and July 2002. Each patient reported a decrease in visual acuity associated with central metamorphopsia in the affected eye a few months before OCT established the diagnosis. The study was approved by ethics committee at Gunma University Hospital and complied with the guidelines of the

Results

Preoperative slit-lamp biomicroscopy showed PVD with a floating Weiss ring in six of nine eyes (Table 1). Three eyes showed no evidence of PVD. OCT demonstrated a slightly detached vitreous cortex in the perifoveal area, but it was attached to the fovea in three eyes (cases 4, 5, and 7). Two of the three eyes had no PVD, but the other had PVD on biomicroscopy. Preoperative OCT failed to detect the presence of a preretinal vitreous cortex in the remaining six eyes. Although six of the nine eyes

Discussion

We performed vitreous surgery in nine eyes of seven cases with foveal detachment and retinoschisis and obtained foveal reattachment and resolution of retinoschisis in eight of nine eyes. All nine eyes had a symptomatic decrease in vision within a few months before OCT established the diagnosis. Preoperative OCT showed a foveal retinal detachment and foveal retinoschisis in all nine eyes. During the preoperative period, the foveal retinal detachment enlarged in one eye (right eye of case 4) (Fig

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Cited by (0)

Manuscript no. 220544.

1

The authors have no proprietary interest in any aspect of this study.

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