Surgical outcome and prognostic factors influencing visual acuity in myopic foveoschisis patients

Abstract

Background: To analyze the optical coherence tomography (OCT) characteristics and visual outcome of vitrectomy in myopic foveoschisis (MF) patients and identify prognostic factors.

Methods: This study is a retrospective clinical cohort study in tertiary care hospital. Thirty-two eyes of 32 patients who underwent MF-related vitrectomy in were investigated retrospectively. Best-corrected visual acuity (BCVA) measured at 1 year post surgery and changes in central foveal thickness (CFT) and co-existing macular pathologies, such as foveal detachment (FD), lamellar holes, and macular holes were the main outcome measures. Prognostic factors were identified using multivariate linear regression analysis.

Results: Average BCVA (in logarithm of the minimum angle of resolution) and mean CFT had improved from 0.46 ± 0.06 to 0.37 ± 0.07 (P = 0.089) and from 485.72 ± 164.69 to 341.71 ± 109.70 (P < 0.001), respectively. Univariate analysis identified baseline BCVA, epiretinal membrane, no coexisting OCT features other than MF, FD on OCT, and gas injection as significantly associated with visual outcome (P < 0.001, 0.014, 0.022, < 0.001, and 0.030). Better baseline BCVA and absence of FD on OCT remained significant (P < 0.001 and < 0.001, respectively) after multivariate analysis.

Conclusion: Good preoperative visual acuity and absence of FD pre-surgery are important predictors of good visual prognosis. Thus, timely surgical intervention, before development of macular complications, may improve visual outcome after surgical treatment of patients with MF.

Fig. 1

This 61-year-old male had MF with FD. His spherical equivalent refractive error was − 12.25 D, and his baseline BCVA was 1.7 log MAR. a The preoperative OCT examination showed a marked splitting of the fovea with posterior staphyloma. b He had received PPV with ILM peeling and SF₆ gas tamponade. After 1 year, OCT examination revealed resolution of foveoschisis. His BCVA improved to 1.0 log MAR. MF: myopic foveoschisis. FD: foveal detachment. D: diopters. BCVA: best-corrected visual acuity. log MAR: logarithm of the minimum angle of resolution. OCT: optical coherence tomography. PPV: pars plana vitrectomy. ILM: internal limiting membrane. SF₆: sulfur hexafluoride