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Katherine Chen, Ching-Lung Chen, Jose Garcia-Arumi, Stanley Chang, Quan V Hoang; Longterm Follow up and Role of Staphyloma Radius of Curvature in Cases of Spontaneous Improvement of Myopic Foveoschisis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5938.
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© ARVO (1962-2015); The Authors (2016-present)
Myopic foveoschisis is the splitting of retinal layers that can occur overlying staphyloma in highly myopic patients and lead to vision loss. Progression of foveoschisis is often attributed to tractional forces at the vitreo-retinal interface. We assess possible contributing mechanisms to the formation of foveoschisis by examining two cases of spontaneous improvement of myopic foveoschisis and employ a radius of curvature measure to track the staphyloma over time.
A retrospective, non-comparative case series was performed and optical coherence tomography (OCT) images were analyzed. Horizontal and vertical images through the staphyloma apex were exported and manually segmented to focus on the retinal pigment epithelial (RPE) layer. RPE radius of curvature (ROC) and root mean square deviation were calculated by curve-fitting in MatLab, and horizontal and vertical values were averaged.
Two cases of myopic foveoschisis with foveal detachments in the left eye (OS) were studied. Both patients had high myopia (either < -10 diopters or > 30 mm in axial length). One case occurred in a treatment-naïve patient who improved after 4 months of observation. On initial presentation, left eye ROC was 12.35 mm, and decreased to 12.15 mm at the time of spontaneous resolution. The other case occurred in a patient who was followed for 7 years, had previously underwent pars plana vitrectomy and removal of epiretinal membrane, experienced recurrence of foveoschisis, and then spontaneously improved without further posterior segment surgery. There was an uncomplicated cataract extraction of the left eye in the interim. On initial presentation, left eye ROC was 4.05 mm, increasing to 4.10 at the time of subretinal fluid recurrence, decreasing to 3.55 mm after cataract extraction and was 3.75 mm at the time of spontaneous resolution. In neither case did there appear to be a correlation between the staphyloma ROC and progression or resolution of foveoschisis.
These cases of “spontaneous” recovery of foveoschisis may be due to changes in tractional forces from the internal limiting membrane or staphyloma.
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