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Artemis Trochanis, David B Yorston; Surgical Outcomes of Vitrectomy for Myopic Foveoschisis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1080.
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© 2017 Association for Research in Vision and Ophthalmology.
Myopic Foveoschisis (MF) is an important cause of visual impairment in high myopia. Vitrectomy is recommended when there is significant or progressive loss of vision and may be accompanied by ILM peel and/or gas tamponade, although the optimum surgical strategy remains uncertain. There are no randomised clinical trials of different techniques, and most case series have come from Asia. To explore visual and anatomical outcomes following surgery and their correlation we reviewed the presenting features and outcomes of seven eyes in six Caucasian patients from a single tertiary centre in Glasgow, Scotland.
Seven highly myopic eyes of six patients (mean age 64.4 years), presenting with MF had vitrectomy, ILM peel and gas tamponade. Main outcome measures included best-corrected visual acuity(VA) and optical coherence tomography(OCT) findings at 6 months after surgery.
OCT findings: One eye had MF alone, three eyes had MF with foveal detachment, and three eyes had MF with a full thickness macular hole (FTMH). Median duration of symptoms was 3 months, and only one patient was symptomatic for less than one month at presentation. Following surgery, OCT showed complete resolution of MF and closure of the FTMH in all eyes. In one eye, the FTMH closed but there was persistent sub-retinal fluid. One eye developed a retinal detachment(RD) approximately six weeks after surgery. Mean pre-operative central foveal thickness was 806(s.d.334) microns. Post-operatively it was reduced to 223(s.d.61) microns, p=0.014 (Student's paired t-test (SPT)). The mean presenting logMAR VA was 0.89(s.d.0.23). The mean post-operative VA was 0.97 (s.d.1.09), which was not different from pre-op VA (p=0.795). Excluding the eye that developed an RD, the mean post-op VA was 0.69 (s.d.0.25), also not significantly better than the pre-op vision (p=0.123, SPT). Four eyes improved by 0.2 or more LogMAR units, two eyes deteriorated by 0.2 or more, and one eye was unchanged.
Therefore, a good anatomical outcome following surgery for MF does not always lead to improved vision. Most case series from Asia show better visual outcomes, which may be due to delayed recognition and later diagnosis of what is a rare condition in W. Europe. Although visual improvement is not as evident as anatomical resolution, the condition is progressive, so stabilisation of visual acuity is likely to be an improvement on the untreated natural history of the condition.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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