Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis

Abstract

Vitrectomy combined with internal limiting membrane peeling (ILMP) treats high myopic foveoschisis with good results, but there is a risk of iatrogenic macular holes, which may be reduced by preserving the internal limiting membrane of the central fovea. This study compared complete ILMP with partial ILMP, both combined with 25G vitrectomy, for the treatment of high myopic foveoschisis.Thirty-three cases (33 eyes) of high myopic foveoschisis were retrospectively analyzed. They underwent 25G vitrectomy combined with C3F8 gas filling; Group A (20 patients, 20 eyes) underwent complete ILMP, while Group B (13 patients, 13 eyes) underwent partial ILMP to preserve the internal limiting membrane of the central fovea. Patients were followed up for 6 months and underwent best corrected visual acuity (BCVA), intraocular pressure, diopter, slit lamp microscopy, indirect ophthalmoscope, A-mode and/or B-mode ultrasound, and optical coherence tomography. Surgical complications were recorded.Up to the last follow-up, the BCVA improved and central fovea thickness (CFT) was lower compared with before surgery in both groups (All P < .05). There were no significant differences in BCVA and CFT at each time point between the groups (P > .05). Most of the postoperative retinas of the 2 groups were completely reattached, with disappearance of the macular retinoschisis cavity. Two patients in the Group A and none in the Group B developed a macular hole during follow-up (P = .508).The results did not support the superiority of partial ILMP over complete ILMP in reduced incidence of macular hole. Both methods had a similar curative effect.

Figure 1

Complete internal limiting membrane peeling for the treatment of high myopic foveoschisis. A, Preoperative optical coherence tomography (OCT). B, OCT at postoperative 1 month: macular retinoschisis was partially improved, with visible macular hole.

Figure 2

Internal limiting membrane peeling with preservation of the foveal internal limiting membrane for the treatment of high myopic foveoschisis. A, Preoperative optical coherence tomography (OCT). B, OCT at postoperative 6 months: the macular retinoschisis cavity had disappeared.