Myopic foveoschisis (MF) has mild early symptoms, however, its course is progressive. When the secondary macular detachment or macular hole occurs, it can cause severe vision loss. Therefore, it is generally believed that MF patients should undergo surgical intervention early after the onset of symptoms to prevent them from further developing into a macular hole or macular hole retinal detachment.It is generally believed that the traction of the vitreous cortex and posterior scleral staphyloma to the retina plays an important role in the occurrence and development of MF. The operation mode is divided into vitreoretinal surgery and macular buckling, the former release the retinal traction via the vitreous body and the latter reattaches the retina via the extrascleral approach. There is no consensus on whether to perform internal limiting membrane peeling and gas tamponade in vitreoretinal surgery and the fovea-sparing internal limiting membrane peeling has become a hot topic in recent years. Compared with vitreoretinal surgery, macular buckling can release the traction of the retina caused by posterior scleral staphyloma, but it cannot relieve the traction in the tangential direction of the retina. Vitreoretinal surgery and extrascleral surgery seems to make up the shortcomings of both, however, the effect of treatment on patients still needs further verification. In clinical work, it is necessary to conduct individualized analysis of MF patients, weigh the advantages and disadvantages of each operation, and choose the most suitable operation mode for patients with different conditions. In the future, the emphasis of our work is to develop operation mode with great curative effect and less complications.
ObjectiveTo observe the changes of vessel densities (VD) in the macula and optic disc and its correlation with axial length (AL) in pathological myopia (PM). MethodsA retrospective clinical study. A total of 171 eyes from 171 patients admitted to Department of Ophthalmology of Jinshan Hospital of Fudan University from June 2019 to December 2019 were included in this study. Among them, there were 72 males and 99 females; age was 35.0±10.8 years old. The patients were divided into PM group, high myopia (HM) group and non-HM group, 51 cases with 51 eyes, 70 cases with 70 eyes, and 50 cases with 50 eyes, respectively. Optical coherence tomography angiography was used to scan the macular and optic disc areas of all the examined eyes in the range of 6 mm×6 mm. According to the early treatment of diabetic retinopathy study, the 6 mm macular and optic disc scan range was centered on the macular fovea and optic disc, respectively, then divided into two concentric circles with diameters of 1 mm of central area, an annulus between 1-3 mm circles of paracentral area. The paracentral area was divided into superior, inferior, nasal, temporal four quadrants by 2 radiation lines. The VD of superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris layer were calculated in the central, superior, inferior, nasal, and temporal areas, respectively. The VD of PM, HM and non-HM groups were compared. The variance analysis was used to compare the VD among the three groups; Pearson’s correlation was used to assess the correlation between VD and AL. ResultsThe perifoveal VD of the SCP, outer retina and choriocapillaris layers were all lower in the PM than those of HM and non-HM group, and the differences were statistically significant (P＜0.05). The VD of DCP macular central was higher in the PM than in the HM group, and the difference was statistically significant (P=0.020). In the optic disc, the VD were lower in the PM group than in the non-HM group except for the area of DCP superior, inferior, temporal, outer retinal center, and the differences were statistically significant (P＜0.05). The results of correlation analysis showed that the VD in the DCP macular central, ONH superior and the choriocapillaris ONH central were not correlated with AL (P=0.647, 0.688, 0.146), and the other VDs were negatively correlated with AL (P＜0.05). ConclusionCompared with HM and non-HM groups, the majority of VDs in macular and ONH are lower in participants with PM.
High myopia macular hole (MH) is a serious complication of high myopia. The main treatment method is surgery. Because of axial growth, posterior scleral staphyloma, choroidal atrophy and other factors, the operation is difficult, the anatomic reduction rate is low, and the visual prognosis is poor. How to improve the reduction rate of surgical dissection and the recovery of visual function is a hot topic. At present, the most popular surgeries include parsplanavitrectomy (PPV) and posterior scleral reinforcement (PSR). However, there are many controversies regarding the treatment of internal limiting membrane in PPV, the selection of vitreous gapfiller, the choice of reinforcement materials and reinforcement methods of PSR, and whether it is necessary to combine PPV and PSR, etc. In recent years, many new surgical methods or techniques have emerged, which significantly increase the success rate of MH.
High myopia is a disease with a high incidence rate and an increasing trend, which could lead to irreversible visual impairment worldwide. Myopia traction maculopathy (MTM), belonging to one of the pathological changes of high myopia, could cause vision damage and even blindness in patients. Recently, a new classification of MTM based on optical coherence tomography can effectively evaluate the condition of patients and is helpful for the diagnosis and treatment of MTM. Moreover, the improvement of internal limiting membrane peeling method and the innovation of macular buckle material provide new ideas for the treatment of MTM based on traditional surgery. New treatment such as vitreal traction release laser surgery, enzymatic vitreolysis and posterior scleral crosslinking have gained increasing attention. By combining these new treatments with artificial intelligence, 3D printing technology and advanced vitrectomy equipment, it is hoped that a safer and more effective treatment for MTM will be found in the future.
ObjectiveTo observe the long-term clinical effect of pars plana vitrectomy combined with fovea-sparing internal limiting peeling in the treatment of macular foveoschisis in pathologic myopic.MethodsA prospective case series study. Fifteen patients (15 eyes) with pathological myopic macular foveoschisis who received treatment in Eye Hospital of Wenzhou Medical University from December 2015 to December 2016 were enrolled. There were 4 males (4 eyes) and 11 females (11eyes), with an average age of 55.33±8.34 years. All patients underwent BCVA, diopter, spectral domain OCT and axial length measurement. The mean logMAR BCVA was 0.95±0.64. The mean central fovea thickness (CFT) was 576.00±185.32 μm. All patients underwent vitrectomy combined with fovea-sparing internal limiting peeling. After gas-liquid exchange, 12% C3F8 was filled and followed up at 1, 3, 6 and 12 months after surgery. Follow-up time was more than 12 months. The structural changes of BCVA and macular area were observed.ResultsThe foveal internal limiting membranes was successfully preserved in all eyes using the techinique. At the final follow-up, the CFT was 258.60±175.22 μm and the BCVA was 0.46±0.43, which were significantly improved compared with preoperative measurements (t=4.90, 5.20; P＜0.001). Macular foveoschisis was resovled in 13 eyes. BCVA increased in 14 eyes. Internal limiting membranes proliferation and contraction occurred in 5 eyes and full-thickness macular hole occurred in 1 eye.ConclusionsPars plana vitrectomy with fovea-sparing internal limiting peeling is effective in the treatment of myopic macular retinoschisis. It can improve BCVA and CFT.
The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
Pathological myopia, characterized by progressive elongation of the axial length and formation of posterior staphyloma, is accompanied by chorioretinal irreversible degeneration. It is also the focus and biggest challenge of myopia control and blindness prevention. For managing progressive early-onset pathologic myopia and myopic traction maculopathy, episcleral pressurization of macula is a practical option. It can be divided into posterior scleral reinforcement surgery and macular buckling surgery according to the presence or absence of operative top pressure ridge after surgery, both of which are different in terms of implanted materials, procedures and indications. The implanted materials, procedures and indications are different between the two. Under the background of soaring prevalence of myopia, it is necessary to modify and cautiously popularize the techniques of episcleral pressurization of macula to provide high level clinical evidence for management of pathological myopia.
Objective To measure the choroidal thickness (CT) in myopic Chinese population and to analyze the correlation factors. Methods One hundred and thirty-four myopia patients (268 eyes) were recruited in this study, including 88 males and 46 females. Ages were from 18 to 38 years, with a mean of (21.5±4.3) years. The spherical equivalent power was -13.13 to -0.50 D, with a mean of (-5.17±2.15) D. The choroid thickness (CT) in macular region was measured by spectral-domain optical coherence tomography. The CT values at subfoveal (SFCT), 1 mm temporal (T1 mm), nasal (N1 mm), superior (S1 mm) and inferior (I1 mm) to the fovea and 3 mm temporal (T3 mm), nasal (T3 mm), superior (S3 mm) and inferior (I3 mm) to the fovea were recorded respectively. The correlation between SFCT and age, uncorrected vision (VAsc), best corrected visual acuity (BCVA), equivalent power, corneal curvature, central corneal thickness and axial length were analyzed. Vision results were converted into logarithm of minimal angle resolution (1ogMAR) so as to analyze statistically. Results The mean SFCT were （230.4±70.2） μm in this study. The SFCT was statistically different from the CT at S1 mm, I1 mm, T1 mm, N1 mm, S3 mm, T3 mm, N3 mm（t=4.279, 2.256, -7.498, 19.020, 7.286, -5.752, 37.921; P＜0.05） respectively, except the CT at I3 mm（t=0.695, P＞0.05）. There was a positive correlation between SFCT and equivalent power （r=0.251, P＜0.05）, corneal curvature （r=0.194, P＜0.05）. The SFCT was negatively correlated with 1ogMAR VAsc （r=-0.279, P＜0.05） and axial length （r=-0.367,P＜0v05）. No correlation was found between SFCT and age, 1ogMAR BCVA and central corneal thickness（r=-0.047, -0.091, -0.068; P＞0.05). Conclusions The SFCT in Chinese myopic subjects is （230.4±70.2） μm. SFCT is correlated with VAsc, equivalent power, corneal curvature and axial length. The axial length is the key factor affecting SFCT.
ObjectiveTo investigate the effects of form deprivation on the morphology of different types of RGC in mice.MethodsSixty B6.Cg-Tg (Thy1-YFP) HJrs/J transgenic mice were randomly assigned to form-deprived group (n=28) and control group (n=32). The right eyes of mice in the form-deprived group were covered by an occluder for 2 weeks as experimental eyes. The right eyes of mice in the control group were taken as control eyes. Before and 2 weeks after form deprivation, the refraction and ocular biometrics were measured; RGC were stained with Bra3a antibody and counted; the morphology of RGC was reconstructed with Neuroexplore software after immunohistochemical staining. The data was compared among experimental eyes, fellow eyes and control eyes by one-way analysis of variance.ResultsTwo weeks after form deprivation, the axial myopia was observed in the experimental eyes (refraction: F=15.009, P＜0.001; vitreous chamber depth: F=3.360, P=0047; ocluar axial length: F=5.011, P=0013). The number of RGC in central retina of the experimental eyes was decreased compared with the fellow eyes and the control eyes (F=4.769, P=0.035). The reconstructed RGC were classified into 4 types according to their dendritic morphology. Form deprivation affected all 4 types of RGC but in a different way. Among them, 3 types of RGC were likely contribute to form vision perception. Form deprivation increased the dendrite branches in these types of ganglion cells. However, form deprivation decreasd dendrite segment numbers in both eyes and the intersection and length insholl analyse type 4 ganglion cells which were morphologically identified as ipRGC.ConclusionForm deprivation distinguishingly affects the morphology of different types of RGC, indicating that form vision and non-form vision play different role in myopia development.
ObjectiveTo compare the clinical characteristics and analyze the factors affecting vision prognosis of idiopathic macular hole (IMH) or myopic macular hole (MMH). MethodsA cross-sectional study. From October 2012 to October 2020, 336 patients with 346 eyes of IMH and MMH who were diagnosed in Shanxi Provincial Eye Hospital with continuous follow-up data after surgery were included. There were 346 eyes (336 cases), including IMH with 247 cases (255 eyes) and MMH with 89 cases (91 eyes), which were divided into IMH group and MMH group. Best corrected visual acuity (BCVA) and optical coherence tomography were performed in all eyes. The BCVA examination used the standard logarithmic visual acuity chart, which was converted into logarithmic minimum angle of resolution (logMAR) visual acuity. The age of outset in IMH and MMH was 64.8±6.6 and 59.2±8.1 years, the logMAR BCVA was 1.11±0.50 and 1.80±0.78, respectively. There were significant differences in age (Wald=34.507) and logMAR BCVA (Z=－7.703) between two groups (P＜0.05). All eyes were performed inner limiting membrane (ILM) peeling or partial inverted ILM covering hole operation. After the operation, the vitreous cavity was filled with air, C3F8 and silicone oil, including 73, 102, 83 eyes in IMH group and 9, 10, 72 eyes in MMH group, respectively. Follow-up time after surgery was more than 2 months. The optimal BCVA and macular hole closure of the two groups were observed. If the quantitative data conformed to the normal distribution, the generalized estimating equation was used, otherwise, the Mann-Whitney U test or Kruskal-wallis test was used, the χ2 test was used for the comparison of categorical variables. Generalized estimating equation logistic regression analyzed the influencing factors of optimal BCVA after surgery and visual acuity success. ResultsIn IMH and MMH, the optimal logMAR BCVA were 0.71±0.36, 1.10±0.51 respectively, and 147 (57.6%, 147/255) eyes, 63 (69.2%, 63/91) eyes achieved visual success respectively. There was a significant difference in the optimal logMAR BCVA (Z=－6.803, P＜0.005), but no difference in visual success rate (χ2=3.772) between the two groups. The visual success rate of IMH at the same baseline BCVA level was higher than that of MMH, and the difference was statistically significant (χ2=14.500, P=0.001). Logistic regression analysis showed that the influencing factors predicting poor optimal visual acuity after surgery were: IMH, baseline BCVA [odds ratio (OR)=2.941, 95% confidence interval (CI) 1.341-6.447, P＜0.05], MH diameter (OR=1.003, 95%CI 1.001-1.005, P＜0.05), silicon oil filling (OR=3.481, 95%CI 1.594-7.605, P＜0.05); MMH, baseline BCVA (OR=2.549, 95%CI 1.344-4.834, P＜0.05), C3F8 filling (OR=18.131, 95%CI 1.505-218.365, P＜0.05) and silicon oil filling (OR=7.796, 95%CI 0.997-60.944, P＜0.05). The factors leading to a lower likelihood of achieving visual success: IMH, baseline BCVA (OR=213.329, 95%CI 46.123-986.694, P＜0.05), MH diameter (OR=0.995, 95%CI 0.992-0.997, P＜0.05), silicon oil filling (OR=0.326, 95%CI 0.115-0.926, P＜0.05) and duration (OR=1.036, 95%CI 1.005-1.067, P＜0.05); MMH, baseline BCVA (OR=13.316, 95%CI 2.513-70.565, P＜0.05) and duration (OR=1.022, 95%CI 1.001-1.044, P＜0.05). ConclusionsMMH was earlier than IMH in age of outset. Baseline vision significantly affected vision prognosis in IMH and MMH. Silicone oil should be avoided as much as possible under the premise of hole closure.