Vitrectomy With Silicone Oil Tamponade and Without Internal Limiting Membrane Peeling for the Treatment of Myopic Foveoschisis With High Risk of Macular Hole Development

Abstract

Purpose: To explore the efficiency and safety of the surgical procedure of pars plana vitrectomy (PPV) with silicone oil (SO) tamponade and without internal limiting membrane (ILM) peeling for myopic foveoschisis (MF) eyes with high risk of macular hole formation. Methods: Three eyes (three patients) with MF and foveal detachment were enrolled into the study. Comprehensive preoperative ophthalmological assessments, including best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were performed on the eyes. Central foveal thickness (CFT) and thickness of continuous neurosensory retina at foveola were measured. All patients underwent PPV followed by SO tamponade and without ILM peeling. SO was removed when MF and retinal detachment were resolved. Patients were followed up postoperative at month 1, 3, 6, and 12. Results: All the three eyes achieved complete resolution of MF and foveal reattachment with an average SO tamponade period of 11.67 ± 0.58 months. The average CFT at 6 months was 91 ± 27.5 μm, hence reduced significantly from baseline at 365.3 ± 137.85 μm (P = 0.037). There was no postoperative macular hole formation despite the average preoperative sensory retina thickness of 58 ± 20.07 μm. Mean BCVA was improved from logMAR 1.43 ± 0.75 to logMAR 0.8 ± 0.75 on the last follow-up. Manageable SO-related complications were reported, including SO emulsification, ocular hypertension, and cataract. Conclusion: Vitrectomy with SO tamponade and without ILM peeling as an optional surgical protocol to treat MF is effective and safe, especially for MF eyes vulnerable to macular hole formation.

Keywords: anatomical outcome; internal limiting membrane; myopic foveoschisis; silicone oil tamponade; vitrectomy.

Figure 1

OCT images of case 1. Left eye with a refractive error (spherical equivalent) of −10.0 diopters in a 47-year-old female: (A) Preoperative OCT image showing outer retinoschisis (asterisks) and FD (triangle), combined with a thickness of 37 μm of continuous neurosensory retina. (B) OCT image at 3 months after vitrectomy with SO tamponade showing a moderate foveoschisis and FD resolution. (C) OCT image at 6 months after vitrectomy with SO tamponade showing a remarkable foveoschisis and FD resolution. (D) OCT image at 11 months after vitrectomy with SO tamponade shows complete foveoschisis and FD resolution, with emulsified SO droplets on the surface of macular (arrow heads). (E) OCT image at 1 week after SO surgical removal does not show MF relapse. (F) OCT image at 12 months after SO surgical removal does not show MF relapse. (G) Preoperative color fundus image. (H) Color fundus image at 11 months after vitrectomy with SO tamponade showing emulsified SO droplets on the surface of retina.

Figure 2

OCT images and anterior segment photographs of case 2. Right eye with a refractive error (spherical equivalent) of −14.0 diopters in a 60-year-old female. (A) Preoperative OCT image showing outer retinoschisis (asterisks), inner retinoschisis (arrow), and foveal detachment (triangle). (B) OCT image at 3 months after vitrectomy with SO tamponade showing slight resolution of the inner retinoschisis, but no change in outer retinoschisis and FD. (C) OCT image at 6 months after SO tamponade showing remarkable foveoschisis and FD resolution. (D) OCT image at 12 months after vitrectomy with SO tamponade showing complete foveoschisis and FD resolution. (E) OCT image at 3 months after SO surgical resection does not show MF relapse. (F) Anterior segment photograph of bilateral eyes at 12 months after SO tamponade. The left image shows visually significant nuclear sclerotic cataracts of the right eye, when compared to contralateral eye. (G) Preoperative fundus image. (H) Color fundus image at 1 month after vitrectomy with SO tamponade. (I) Color fundus image at 3 months after SO removal surgery.

Figure 3

OCT images of case 3. Right eye with a refractive error (spherical equivalent) of −12.0 diopters in a 65-year-old female: (A) Preoperative OCT image showing retinoschisis and foveal detachment, with a height of 518 μm. (B) OCT image at 3 months after vitrectomy with SO tamponade showing a moderate foveoschisis and FD resolution. (C) OCT image at 8 months after SO tamponade showing a remarkable foveoschisis and FD resolution. (D) OCT image at 12 months after vitrectomy with SO tamponade showing a complete foveoschisis and FD resolution. (E) OCT image at 3 months after SO surgical removal does not show MF relapse. OCT, optical coherence tomographic; FD, foveal detachment; SO, silicone oil.