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Background Myopic foveoschisis (MF) is among the leading causes of visual loss in high myopia. However, it remains controversial whether internal limiting membrane (ILM) peeling or gas tamponade is necessary treatment option for MF. Methods PubMed, EMBASE, CBM, CNKI, WANFANG DATA and VIP databases were systematically reviewed. Outcome indicators were myopic foveoschisis resolution rate, visual acuity improvement and postoperative complications. Results Nine studies that included 239 eyes were selected. The proportion of resolution of foveoschisis was higher in ILM peeling group than non-ILM peeling group (OR = 2.15, 95% CI: 1.06–4.35; P = 0.03). The proportion of postoperative complications was higher in Tamponade group than non-Tamponade group (OR = 10.81, 95% CI: 1.26–93.02; P = 0.03). However, the proportion of visual acuity improvement (OR = 1.63, 95% CI: 0.56–4.80; P = 0.37) between ILM peeling group and non-ILM peeling group and the proportion of resolution of foveoschisis (OR = 1.80, 95% CI: 0.76–4.28; P = 0.18) between Tamponade group and non-Tamponade group were similar. Conclusions Vitrectomy with internal limiting membrane peeling could contribute to better resolution of myopic foveoschisis than non-peeling, however it does not significantly influence the proportion of visual acuity improvement and postoperative complications. Vitrectomy with gas tamponade is associated with more complications than non-tamponade and does not significantly influence the proportion of visual acuity improvement and resolution of myopic foveoschisis. Electronic supplementary material The online version of this article (10.1186/s12886-017-0562-8) contains supplementary material, which is available to authorized users.

To describe the technique and surgical outcomes of a modified large semicircular inverted internal limiting membrane (ILM) flap in the management of macular holes (MHs) in patients with high myopia. We performed this retrospective study on consecutive patients with MH and high myopia (axial length ≥ 28 mm),who received vitrectomy, a large semicircular ILM flap 4 discs in diameter to cover the MH, incomplete air–fluid exchange, and SF6 gas tamponade. All of the patients maintained an upright position for 2 h postoperatively, followed by either a face-down or upright position for 1 week. Post-operative visual acuity was measured, and MH status was assessed using spectral-domain optical coherence tomography. Seventeen highly myopic eyes in 16 patients with a mean axial length of 30.49 ± 0.98 mm and mean age of 62.25 ± 9.40 years were included in this study, including five eyes with foveoschisis and four eyes with chronic MH, two with myopic choroidal neovascularization, and four with MH-associated retinal detachment. The MHs of all patients were successfully closed after a single operation. All of the patients were followed for at least 6 months. The average visual acuity in logarithm of minimal angle of resolution improved from 1.26 ± 0.52 preoperatively to 0.69 ± 0.45 6 months postoperatively (p = 0.01, paired t-test). A large semicircular inverted ILM flap can close a myopic MH efficiently without the need for a long-term face-down position.

AIM To report the long-term surgical outcomes of pathologic myopic foveoschisis (MF) following vitrectomy. METHODS We performed a retrospective case series analysis of 50 consecutive patients diagnosed with MF who experienced vision loss due to progression of foveoschisis. The 50 patients (67 eyes) were treated in our hospital with vitrectomy with internal limiting membrane (ILM) peeling from December 2004 to September 2010. Best corrected visual acuity (BCVA), refractive error, optical coherence tomography (OCT), and routine examination results were analysed. The changes of BCVA, foveal anatomical features on OCT scan, and complications were the main outcome measures. RESULTS The mean follow-up duration was 42±17mo (range 24 to 93mo). BCVA improved significantly postoperatively (0.76±0.65 logMAR) compared with preoperative baselines (1.31±0.78 logMAR, P

Purpose: To evaluate the surgical outcomes of macular hole (MH) repair by vitrectomy and internal limiting membrane peeling in highly myopic eyes. Methods: In this retrospective interventional case series, 30 highly myopic eyes with MH in 29 consecutive patients who underwent vitrectomy and internal limiting membrane peeling to repair MH were studied. The mean follow-up time was 36.4 months. The anatomical outcomes of the MH were evaluated by optical coherence tomography. The best-corrected visual acuities before and after surgery were compared as the functional outcome. Results: Women accounted for 69% of MH in highly myopic eyes. The mean age was 49 years. The mean refraction error and mean axial length were −9.80 (±2.93) diopter and 28.13 (±2.41) mm, respectively. Myopic foveoschisis was observed in 3 eyes (10%). The MHs were closed by a single surgery in 26 eyes (87%), and the final closure rate was 97% (29/30 eyes). Macular hole surgery significantly improved best-corrected visual acuity from 1.20 ± 0.70 to 0.77 ± 0.51 logarithm of the minimum angle of resolution (P = 0.003). However, rhegmatogenous retinal detachment developed in 3 eyes (10%) during the follow-up. Conclusion: Vitrectomy with internal limiting membrane peeling is effective to repair MH in highly myopic eyes in terms of anatomical and functional outcomes, although visual acuity may continue to improve slowly until 3 years after successful MH-closing surgery. In addition, a small proportion of MH cases were associated with myopic foveoschisis. Delayed hole closure and rhegmatogenous retinal detachment may occur in these highly myopic eyes after surgery.

Purpose: To evaluate the outcome of vitrectomy with internal limiting membrane peeling and no gas tamponade in the treatment of eyes with myopic foveoschisis. Methods: Medical records of 10 eyes of 9 consecutive patients with myopic foveoschisis without macular hole treated by vitrectomy were reviewed. Results: The patients' refractive error was −4.00 diopters to −34.00 diopters, and axial length was 28.38 mm to 35.90 mm. Six eyes had foveal retinal detachment with retinoschisis. All cases were treated by vitrectomy with internal limiting membrane removal without gas tamponade. The mean preoperative best-corrected visual acuity was 0.61 ± 0.42 in logarithm of the minimum angle of resolution units (Snellen equivalent of 20/82). Myopic foveoschisis was reduced in 8 eyes (80%) with a single surgery. Two eyes without improvement developed a postoperative macular hole and were treated by additional vitreoretinal surgery. All 10 eyes showed anatomical repair, and 5 eyes showed improvement in best-corrected visual acuity to 0.47 ± 0.48 (Snellen equivalent of 20/60), by 17 months after the initial surgery. Conclusion: Vitrectomy with internal limiting membrane peeling and no gas tamponade can effectively treat some cases of myopic foveoschisis, suggesting that tractional forces at the vitreoretinal interface may contribute to the pathogenesis of myopic foveoschisis, thereby avoiding gas tamponade.

Purpose To evaluate the efficacy of supra choroidal buckling procedure using a supra choroidal catheter, as a new approach in treating myopic vitreomacular interface disorders specially in difficult cases of myopic traction maculopathy with or without macular hole retinal detachment in posterior staphyloma depending on the concept of indenting the choroid only, from a 1-year data study. Methods A newly developed supra choroidal catheter was used to deliver stabilized, cross-linked, long-acting hyaluronic acid as a filler in the supra choroidal space in the area of the staphyloma forming a choroidal indenting effect. Before the injection, pars plana vitrectomy was performed without internal limiting membrane peeling to avoid the risk of break of the roof of foveal detachment in case of foveoschisis. This indentation was used to treat 11 patients with myopic foveoschisis and 12 patients with myopic macular hole retinal detachment, 5 of whom had failed primary repair by vitrectomy before inclusion in this trial. Clinical and optical coherence tomographic evaluations of these patients were performed over 1-year follow-up. Results Retinal layer restoration was achieved in all 11 eyes with myopic foveoschisis. This was gradual over a period of 2 to 6 weeks postoperatively. No recurrence over the 12-month follow-up was observed. Visual acuity improved by 1 line or more in 9 eyes (81.8%). Of the 12 eyes, 10 with macular hole detachment (83%) showed closure of the holes in association with the resolution of the detachment; 2 eyes showed resolution of the detachment and flatting of the edge of the holes but with incomplete closure on optical coherence tomography. Eight eyes (66.6%) showed improvement in visual acuity by 1 or more lines with no recurrence of retinal detachment over the 12-month follow-up period. The indentation effect was sufficient over the 12-month follow-up period. Conclusion The indentation effect achieved by supra choroidal approach can be used as a method of managing myopic foveoschisis and myopic macular hole with detachment even in eyes with failed primary vitrectomy, counteracting the role of posterior staphyloma in the role of the disease. The indentation effect is sufficient for first year of follow-up.

Myopic foveoschisis is one of the major complications of pathologic myopia, and it was most recently identified by new imaging modalities. During the natural evolution of this complication, anatomical and visual improvement without surgical intervention is an unusual course, and most of these eyes remain stable or progressively worsen. The authors report a case of a highly myopic eye that developed patchy chorioretinal atrophy after spontaneous resolution of myopic foveoschisis, which to the best of our knowledge has not been reported previously in the medical literature.

The use of endotamponade agents has gained a major role in the management of macular complications of high myopia. Myopic foveoschisis and macular hole are the main macular complication of pathologic myopia, this growing condition that is a main cause of visual loss, especially in patients at a younger age. We discuss the physical properties and advantages and disadvantages of the main ocular tamponade agents used in the treatment of these diseases.

Resume Introduction Le foveoschisis maculaire du myope fort est une pathologie rare caracterisee par un clivage intra-retinien associe a des anomalies du cortex vitreen et parfois a une retraction corticale. L’evolution est imprevisible, le traitement est chirurgical avec un pronostic fonctionnel souvent favorable. Materiel et methodes Nous rapportons 7 cas de foveoschisis maculaire sur des yeux myopes forts. Nous decrivons les aspects OCT de ces foveoschisis, ainsi que les signes associes tout en essayant de les correler au niveau d’acuite visuelle. Resultats Le foveoschisis etait muet a l’examen clinique et decouvert uniquement a l’OCT dans 4 yeux. L’epaisseur centrofoveolaire moyenne etait de 540 μm. L’acuite visuelle moyenne etait de 1/10–P10. Plus la retine etait epaissie, moins bonne etait l’acuite visuelle. La presence d’un decollement sereux de la retine ne semble pas influer le niveau d’acuite visuelle. Une membrane epimaculaire ou une retraction du cortex vitreen serait une cause de baisse de l’acuite visuelle. Conclusion L’OCT se revele particulierement utile dans le diagnostic des causes de baisse visuelle chez le myope fort, notamment le foveoschisis. Les correlations anatomiques et fonctionnelles au cours du foveoschisis du myope fort ne sont pas encore clarifiees. Le decollement de la retine du pole posterieur et le trou maculaire sont les complications les plus graves.

PURPOSE To evaluate a new application of an expanded polytetrafluoroethylene (Gore-Tex) vascular graft for use in macular buckling surgery for treatment of highly myopic eyes. METHODS The Gore-Tex vascular graft was used as a macular buckling material in eight consecutive cases of myopic macular diseases which included fovea detachment, foveoschisis, or macular hole retinal detachment. RESULTS Retinal reattachment was achieved in all cases except one which had partial resolution (88%). The postoperative best-corrected visual acuity ranged from 20/2000 to 20/100 depending on the degree preexisting macular degeneration, and significant better than the preoperative best-corrected visual acuity (P = 0.048, paired t-test). During the follow-up period, which ranged from 8 months to 3 years, no eye developed buckle-related complications such as infection or dislocation. CONCLUSION The initial pilot results from this series using a Gore-Tex graft for macular buckling is promising. Throughout the follow-up period, the Gore-Tex was well tolerated in the highly myopic eyes. Large scale and long-term follow-up is warranted.

Vitrectomy combined with internal limiting membrane peeling (ILMP) treats high myopic foveoschisis with good results, but there is a risk of iatrogenic macular holes, which may be reduced by preserving the internal limiting membrane of the central fovea. This study compared complete ILMP with partial ILMP, both combined with 25G vitrectomy, for the treatment of high myopic foveoschisis. Thirty-three cases (33 eyes) of high myopic foveoschisis were retrospectively analyzed. They underwent 25G vitrectomy combined with C3F8 gas filling; Group A (20 patients, 20 eyes) underwent complete ILMP, while Group B (13 patients, 13 eyes) underwent partial ILMP to preserve the internal limiting membrane of the central fovea. Patients were followed up for 6 months and underwent best corrected visual acuity (BCVA), intraocular pressure, diopter, slit lamp microscopy, indirect ophthalmoscope, A-mode and/or B-mode ultrasound, and optical coherence tomography. Surgical complications were recorded. Up to the last follow-up, the BCVA improved and central fovea thickness (CFT) was lower compared with before surgery in both groups (All P .05). Most of the postoperative retinas of the 2 groups were completely reattached, with disappearance of the macular retinoschisis cavity. Two patients in the Group A and none in the Group B developed a macular hole during follow-up (P = .508). The results did not support the superiority of partial ILMP over complete ILMP in reduced incidence of macular hole. Both methods had a similar curative effect.

Purpose: To describe the spectral-domain optical coherence tomographic characteristics, natural course and surgical management for eyes with myopic foveoschisis. Methods: The medical records of 39 consecutive patients (56 eyes) with myopic foveoschisis were retrospectively reviewed. Pars plana vitrectomy with internal limiting membrane peeling and Brilliant Blue G staining was performed on 16 symptomatic eyes (14 patients). Results: Optical coherence tomography at baseline showed an isolated foveoschisis in 62.5%, foveal detachment in 21.4%, and a lamellar hole in 16.1% of the eyes. After a mean follow-up period of 15.7 months, 1.8% of the eyes developed a full-thickness macular hole and 28.5% of the eyes required surgery. The mean preoperative visual acuity (VA) was 20/63 and the mean central retinal thickness (CRT) was 507.6 µm. The mean postoperative VA was 20/40 and the mean CRT 282.9 µm. Anatomical success was achieved in 75% of the eyes at a mean of 3.3 months after surgery, and 81.2% of the eyes had an improvement of 2 lines of VA. Conclusion: Myopic foveoschisis remained stable in most eyes; however, 28.5% of the eyes had decreases in VA secondary to progression of the foveoschisis and required surgery.

Background Macular hole (MH) with associated foveoschisis is very specific to highly myopic eyes with a pronounced posterior staphyloma. A high axial length increases the risk of foveoschisis, MH formation and retinal detachment secondary to a macular hole (MHRD). These highly myopic MH show poor surgical outcomes after vitrectomy and internal limiting membrane peeling compared with non-myopic MH. The posterior staphyloma seems to play an important role, and thus macular buckling could prove useful to improve both visual and anatomical results. Methods Sixteen highly myopic eyes with MH and associated foveoschisis that underwent macular buckling were studied. Vitrectomy combined with macular buckling was performed in all 16 eyes. Optical coherence tomography was performed to confirm MH closure in all cases. Results Combined vitrectomy and macular buckling resulted in MH closure in all patients. Best-corrected visual acuity (BCVA) improved in 13 out of 16 eyes (81.25%), remained stable in 2 eyes (12.5%) and worsened in 1 eye (6.25%). Mean preoperative BCVA was 20/125, whereas mean postoperative BCVA was 20/50. Conclusions Combined vitrectomy and macular buckling is a safe and effective approach to achieve primary closure of MH in eyes with posterior staphyloma and associated foveoschisis. Eyes with a high axial length show a less favourable prognosis, which can be partially overcome by means of macular buckling.

Purpose: To report the anatomic and visual results following macular buckling for patients with macular retinoschisis related to high myopia. Methods: Thirty-nine highly myopic eyes (mean refractive error 16.7 D; range, 9t o24 D) of 36 patients (mean age 59 years; range, 35–79 years) presenting with macular retinoschisis associated with a posterior staphyloma, who underwent combined vitrectomy and macular buckling were evaluated. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) findings. Three cases were excluded due to short follow-up (less than 3 months). The mean followup was 16 months. Results: The mean BCVA increased from 0.76 to 0.43 LogMAR (p = 0.001). Visual acuity improved in 30 eyes (83.3%), remained stable in three eyes (8.3%) and decreased in three eyes (8.3%). OCT showed resolution of foveoschisis with foveal reattachment in all eyes. None of the evaluated patients developed a macular hole during follow-up. Conclusion: Macular buckling associated with vitrectomy results in good anatomic and visual outcomes in patients with myopic foveoschisis.

PURPOSE To evaluate the prevalence of macular complications in tilted disk syndrome by spectral domain optical coherence tomography (OCT). METHODS A monocentric retrospective study of consecutive patients with tilted disk syndrome, whose eyes were examined by spectral domain OCT (Cirrus; Zeiss) and fundus photography. RESULTS Fifty consecutive patients (39 women and 11 men; age range, 41-96 years) with uni- or bilateral tilted disk syndrome were enrolled. All affected eyes (n = 92) were imaged by spectral domain OCT and fundus photography. Fluorescein and/or indocyanine green angiography were performed in 33 patients (66%). Macular anomalies or complications were observed in 71 eyes (77.1%). Specifically, retinal pigment epithelial changes were described in 34 eyes (36.9%), choroidal neovascularization in 24 eyes (26%), and macular serous retinal detachment in 16 eyes (17.3%). Epiretinal membrane in 9 eyes (9.7%), myopic foveoschisis in 5 eyes (5.4%), and lamellar macular hole in 3 eyes (3.2%) were also detected relatively frequently by spectral domain OCT. Surprisingly, fovea plana was observed in 5 eyes (5.4%). Eleven eyes, complicated by choroidal neovascularization, were treated with ranibizumab, with a mean visual gain of 7.9 letters on Early Treatment Diabetic Retinopathy Study chart. CONCLUSION Tilted disk syndrome can be associated with potentially severe macular complications. Spectral domain OCT allowed the recognition of additional macular changes associated with tilted disk syndrome, such as epiretinal membranes, myopic foveoschisis, and fovea plana.

To assess the role of Spectral Domain Optical Coherence Tomography (SD-OCT) measurements as prognostic factors in myopic macular hole (MMH) surgery. In a retrospective cohort study, we evaluated 42 eyes of 42 patients (Spherical equivalent > −6.00 D) who underwent pars plana vitrectomy with internal limiting membrane peeling for MMH without foveoschisis. Statistical analysis was performed to correlate postoperative best corrected visual acuity (BCVA) with preoperative BCVA, age, degree of myopia and seven preoperative OCT measurements: macular hole (MH) base, MH minimum diameter, MH height, Hole Form Factor (HFF), Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI). Primary and final anatomical success rate were 83.3 % (35/42) and 90.5 % (38/42), respectively. Four patients deferred reoperation and three underwent a second surgical approach to achieve MH closure. A posterior staphyloma was observed in 27 of 42 patients, and in three of them the MH was located in the apex of the staphyloma. Two of these three cases showed an open MH after the first surgery. Postoperative visual acuity improved in 22/42 (52.4 %) patients, worsened in 7/42 (16.7 %) and remained unchanged in 13/42 (30.9 %). Only MH minimum diameter (P = 0.03) and HFF (P = 0.02) correlated significantly with postoperative BCVA. Minimum diameter and HFF are strongly correlated with postoperative visual outcomes in cases of MMH. Since analyzing MH configuration seems to improve the anatomical success rate after vitreous surgery in highly myopic patients, these parameters should be preoperatively evaluated by SD-OCT.

Pathological myopia, characterized by elongation of the axial length, is a common cause of social blindness worldwide, especially in East Asian countries. The incidence of high myopia is 5.5 % (>−6.0 diopters [D]) in Japan (Sawada et al. 2008) and 3.3 % (

To identify the risk factors for the development of macular hole retinal detachment (MHRD) after vitrectomy without internal limiting membrane peeling for pathologic MF. We retrospectively reviewed the records of 131 eyes (115 patients) treated with vitrectomy for pathologic MF from 2009 to 2014. The best-corrected visual acuity (BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings were analyzed. Postoperative MHRD developed in 7 eyes (5.3%). Between patients with or without secondary MHRD after vitrectomy, there were no significant differences in age, sex, axial length, preoperative BCVA, refractive error, lens status, and presence of posterior staphyloma. Spectral-domain optical coherence tomography showed all 7 eyes (100%) had foveal detachment, while only 47 patients (37.9%) of 124 eyes had foveal detachment (P = 0.004). There was no significant difference between preoperative and postoperative BCVA in the 7 eyes with MHRD. The postoperative BCVA in the 124 eyes without MHRD was significantly improved (P < 0.001). Among the 124 eyes, both preoperative and postoperative BCVA of eyes with foveal detachment was worse than the eyes without foveal detachment (P < 0.001, respectively). Preoperative foveal detachment is a risk factor for the development of MHRD after vitrectomy for pathologic MF.

Sir, Goel and Ghosh present a very interesting case in their report entitled, “Temporary resolution of foveal schisis following vitrectomy with silicon oil tamponade in X-linked retinoschisis with retinal detachment.”[1] The authors document with the help of optical coherence tomography, temporary resolution of foveal schisis in a case operated for retinal detachment with X-linked retinoschisis, that recurred after silicone oil removal. The case not only provides an insight into pathology of the inherited disorder but also underlines the irreversible visual loss that may be associated with foveal schisis. Visual acuity had improved to 20/120 at the time when foveal schisis had temporarily resolved due to oil tamponade, but after its recurrence following oil removal, the visual acuity remained similar, 20/80, instead of decreasing that one may expect. Therefore, morphological alignment of the middle retinal layers did not contribute to visual acuity which had been lost permanently. Although good results with surgery have been published earlier,[2] surgery for foveal schisis alone hence may not always be fruitful. Another valuable conclusion that one may draw from this unique case is that the best time to perform internal limiting membrane (ILM) peel in such cases of retinal detachment would be during oil removal rather than during vitrectomy itself. Macula at that time would be more resistant to inadvertent damage due to manual traction. The authors too mention the controversy surrounding ideal treatment of X-linked foveal schisis and the risk of macular complication during ILM peel in patients with foveal schisis. We keenly await the authors' response. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Objective: To report the clinical and surgical outcomes of patients with myopic foveoschisis (MF).Methods: Thirteen eyes in ten symptomatic MF patients who underwent pars plana vitrectomy (PPV) and gas tampon­ade with internal limiting membrane (ILM) peeling were retrospectively identified. Best corrected visual acuity (BCVA) and central foveal thickness (CFT) were assessed preoperatively and six months postoperatively. Complications during and after surgery were also recorded.Results: The median BCVA significantly improved from 20/160 to 20/100 (p = 0.03). In subgroup analysis, eight eyes (61%) demonstrated significant BCVA improvements from 20/80 to 20/50 (p < 0.001), whereas five eyes had similar BCVA with preoperative level after six months of surgery (p=0.32). The mean CFT decreased from 526 microns at base­line to 214 microns at six months of surgery (p < 0.001). Optical coherence tomography scans revealed a complete MF resolution in ten eyes (76%) and a partial MF resolution in three eyes. Peripheral retinal tear was developed in one patient during surgery and one patient had cataract after surgery, those were treated accordingly.Conclusion: PPV with ILM peeling followed by gas tamponade is a safe and effective procedure for the treatment of eyes with myopic foveoschisis. Larger studies with longer follow-ups will further establish the efficacy and safety of this procedure. J Clin Exp Invest 2016; 7 (2): 139-143

Purpose To investigate the safety and efficacy of a novel macular buckling technique on foveoschisis in highly myopic eyes. Methods Highly myopic eyes with foveoschisis, posterior staphyloma, and axial length greater than 26.5 mm, but without a full-thickness macular hole, were included. Macular buckling was performed in the included eyes using a three-armed adjustable silicon capsule. Results Eight eyes from eight patients (five women) were enrolled in this study. The mean follow-up period was 11.6 (range 9-14) months. After surgery, the best-corrected visual acuity was improved in 7/8 (87.5%) eyes, optical coherence tomography imaging showed gradual anatomic improvement of macula over time. The final best-corrected visual acuity gained 21.5 early treatment diabetes retinopathy study letters from baseline on average (P = 0.014). Postoperatively, the most common complications were transiently elevated intraocular pressure (62.5%) and asymptomatic abduction limitation (100%), and the most serious complication was hemorrhagic choroidal detachment (25%). Conclusion Macular buckling with a three-armed adjustable silicone capsule resulted in anatomic and visual improvement in eyes with myopic foveoschisis.

AIM: To investigate the effects of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis. METHODS: Thirty-nine highly myopic eyes of 39 patients with myopic foveoschisis underwent PSR combined with vitrectomy. Best corrected visual acuity (BCVA), refraction error, and the foveal thickness by optical coherence tomography (OCT) were recorded before and after the surgery, and complications were noted. RESULTS: The follow-up period was 12mo, and the main focus was on the results of the 12-month follow-up visit. The mean preoperative BCVA was 0.96±0.43 logMAR. At the final follow-up visit, the mean BCVA was 0.46±0.28 logMAR, which significantly improved compared with the preoperative one (P=0.003). The BCVA improved in 33 eyes (84.62%), and unchanged in 6 eyes (15.38%). At the end of follow-up, the mean refractive error was -15.13±2.55 D, and the improvement was significantly compared with the preoperative one (-17.53±4.51 D) (P=0.002). Twelve months after surgery, OCT showed complete resolution of the myopic foveoschisis and a reat¬tachment of the fovea in 37 eyes (94.87%) and partial resolution in the remained two eyes (5.13%). The foveal thickness was obviously reduced at 12-month follow-up visit (196.45±36.35 μm) compared with the preoperative one (389.32±75.56 μm) (P=0.002). There were no serious complications during the 12mo follow-up period. CONCLUSION: PSR combined with vitrectomy is a safe and effective procedure for myopic foveoschisis with both visual and anatomic improvement.

PURPOSE To assess functional and structural outcome after adjustable macular buckling for the treatment of foveoschisis (FS), associated with full-thickness macular hole (FTMH) in highly myopic eyes. METHODS Eighteen consecutive patients who underwent adjustable macular buckling for FS associated with FTMH were included in this prospective study. Three cases were not included in the analysis due to short follow-up period (less than 3 months). Outcome measures included anatomical success rate with FS resolution and FTMH closure, best-corrected visual acuity, mean retinal sensitivity, central retinal thickness, and fixation site and stability. RESULTS Foveoschisis resolution and FTMH closure were observed in all cases between 1 month to 3 months after surgery. At 24 months of follow-up visit visual acuity improved in 13/15 eyes (86.7%) and remained stable in 2 (13.3%). Mean retinal sensitivity showed significant improvement from baseline 5.69 ± 3.52 dB to final 8.35 ± 3.86 dB; P < 0.001. Fixation stability inside central 4° improved from baseline 58.5 ± 17.8% to final 73.7 ± 23.0%; P = 0.009. Central retinal thickness did not change significantly throughout follow-up. No FTMH or FS recurrence occurred and no surgical complications arose. CONCLUSION Adjustable macular buckling exoplant may represent an effective surgical option for the treatment of FS associated with FTMH in highly myopic eyes. Adjustable macular buckling showed high closure rate and virtually no tendency to recur. Functional results and safety are also interesting because vision improved and retinal thickness did not reduce significantly at 24 months of follow-up.

PURPOSE To identify spectral-domain optical coherence tomography findings related to visual outcome in myopic foveoschisis after 25-gauge transconjunctival sutureless vitrectomy. METHODS Thirty-eight eyes with myopic foveoschisis were prospectively followed-up to 6 months after vitrectomy. Best-corrected visual acuity (BCVA), axial length, and spectral-domain optical coherence tomography findings were analyzed for identification of factors affecting visual outcome. RESULTS Best-corrected visual acuity improved significantly (preoperative 0.841 ± 0.534 logarithm of minimal angle of resolution to postoperative 0.532 ± 0.536 logarithm of minimal angle of resolution, P = 0.001), and central retinal thickness showed significant reduction (preoperative 409 ± 143 μm to postoperative 259 ± 72 μm, P < 0.001) with surgery. Anatomical success was achieved in 34/38 eyes (89.5%). Photoreceptor layer disruption was found in 20 of 38 eyes (52.6%) preoperatively and persisted after surgery in 18 of 20 eyes (90.0%). Patients with preoperative photoreceptor layer defects had significantly more associated foveal detachments and irregular choroidal surfaces and worse preoperative and final best-corrected visual acuity. Preoperative best-corrected visual acuity showed significant correlation with final best-corrected visual acuity (Pearson correlation coefficient = 0.555, P = 0.001). Patients with irregular choroidal surfaces and photoreceptor layer disruption had significantly worse final best-corrected visual acuity (P = 0.035, 0.005). CONCLUSION Twenty-five-gauge transconjunctival sutureless vitrectomy showed favorable results for the management of myopic foveoschisis. Photoreceptor layer defects and irregular choroidal surfaces on spectral-domain optical coherence tomography persist despite surgery, limiting visual outcome.

PURPOSE To assess the rate of complete posterior vitreous detachment (PVD) in highly myopic eyes requiring vitreoretinal surgery based on intraoperative observations. METHODS Monocentric retrospective observational case series of consecutive highly myopic patients whose eyes underwent 25 G 3-port pars plana vitrectomy between 2009 and 2012. Patients were operated on for rhegmatogenous retinal detachment, epiretinal membrane, macular hole with retinal detachment, myopic foveoschisis, and myopic macular hole. Patient records were reviewed focusing on the intraoperative assessment of PVD which was assisted in most cases by a visualization agent. RESULTS Ninety-six eyes of 95 patients whose mean age was 62.15 ± 12.4 years (29-95) were included. Complete PVD was observed in 52.1% of eyes. The PVD rate varied depending on the disease (P < 0.0001). It was high in retinal detachment and epiretinal membrane (85 and 74.2%, respectively) and low in myopic foveoschisis and myopic macular hole (14.3 and 10%, respectively). Complete PVD was found in 42.9% of macular hole with retinal detachment. CONCLUSION In highly myopic eyes, the rate of complete PVD varied widely depending on the vitreoretinal disease operated on. The posterior vitreous cortex was often detached from the retina in retinal detachment and epiretinal membrane but was most often attached in myopic foveoschisis and macular hole.

Purpose Myopic foveoschisis occurs in 9–34% of highly myopic eyes with posterior staphyloma. The pathogenesis is still not fully understood. But the relative inflexibility of the inner retina and a tangential traction induced inward traction force in the posterior staphyloma are possible mechanisms. Conventional internal limiting membrane (ILM) peeling generally yields good results. However, a postoperative full-thickness macular hole happens in 13–28% of cases. Therefore, this study describes a modified ILM peeling technique named ‘ILM maculorrhexis’ to minimize the occurrence of postoperative macular hole in patients with foveoschisis. Methods This retrospective case review that included 10 eyes of 10 consecutive patients who underwent vitrectomy with ILM maculorrhexis to treat myopic foveoschisis was studied. After surgery, complete ophthalmic examination and SD-optic coherence tomographic examinations were performed 1, 3, 6, 9 and 12 months postoperatively. Results After surgical intervention, the foveoschisis resolved dramatically in all 10 eyes. The mean central foveal thickness decreased significantly from 840 μ to 273 μ at 12 months postoperatively. Mean LogMAR best-corrected visual acuity improved from 1.04 preoperatively to 0.59 12 months postoperatively. After the follow-up time of at least 12 months, all 10 eyes remained fovea attached, and none of the 10 eyes developed macular hole. Conclusions This technique minimizes traction force over the extremely thinned foveal tissue in highly myopic eyes. In the long-term follow-up of at least 12 months, all 10 cases had good anatomic and visual results. But we still need a larger case number and longer follow-up for further evaluation.

The purpose of the study was to evaluate visual and anatomical outcomes in patients with myopic foveoschisis who underwent vitrectomy and internal limiting membrane (ILM) peeling with perfluoropropane (C3F8) tamponade or balanced saline solution in the vitreous cavity.Retrospective comparison of a consecutive surgical series. Eighteen eyes of 17 patients scheduled for myopic foveoschisis surgery were recruited at the affiliated Eye Hospital of Wenzhou Medical College, Zhejiang, China. Pars plana vitrectomy and ILM peeling with indocyanine green staining were performed in all patients. Refractive lens exchange was simultaneously performed in 12 phakic eyes. Finally, the vitreous cavity was filled with balanced saline solution in seven eyes of seven patients (Group A). Fluid-air exchange was performed in another 11 eyes of 11 patients (Group B), followed by injection of 18% C3F8. Patients were evaluated using best-corrected visual acuity (BCVA) testing and optical coherence tomography scans.All patients completed more than 6 months of follow-up. In two groups, preoperative factors were not significantly different. In Group B, the postoperative BCVA was significantly greater than the preoperative BCVA (t = 4.401, P = 0.001) but not significantly different in Group A (t = 1.970, P = 0.096). The BCVA change in Group B was significantly greater than Group A at the last visit (Z = 2.23, P = 0.025). In both groups, the BCVA change was significantly correlated with the preoperative BCVA, respectively. The BCVA was improved by 0.2 logarithm of the minimum angle of resolution or more in 10 eyes (91%) in Group B and 4 eyes (56%) in Group A. All eyes in both groups did not have decreases in the postoperative BCVA. In 3 months after vitrectomy, 6 eyes in Group A did not have anatomical resolutions. However, it was interesting to see that the height of retinoschisis at the central macular region gradually decreased until anatomical resolution was achieved. In Group B, all eyes had anatomical resolutions in 3 months after vitrectomy. None of the eyes developed macular hole during the surgery and the period of routine follow-up period.Vitrectomy with ILM peeling does not increase the risk of iatrogenic macular hole formation. The poor elasticity of the ILM and the traction of membranous structure on the surface of the ILM play important roles in the development of myopic foveoschisis. In eyes undergoing vitrectomy and ILM peeling for myopic foveoschisis, C3F8 tamponade results in more rapid anatomical resolution and greater improvement in BCVA than balanced saline solution.

Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS). Posterior microphthalmos (PM) is a relatively infrequent type of microphthalmos where posterior segment is predominantly affected with normal anterior segment measurements. Herein, we report two siblings with posterior microphthalmos retinopathy syndrome with postulated autosomal recessive mode of inheritance. A 13-year-old child had PM and retinitis pigmentosa (RP) and his 7-year-old sister had PM, RP, and foveoschisis. The genetics of this syndrome and variable phenotype is discussed. Importance of being aware of posterior microphthalmos and its posterior segment associations is highlighted.

PURPOSE The purpose of this study was to determine the factors that are correlated with the visual outcomes in patients who underwent pars plana vitrectomy with internal limiting membrane peeling for myopic foveoschisis (MF). METHODS In this retrospective, interventional consecutive case series, 39 eyes of 39 consecutive patients who had undergone pars plana vitrectomy with internal limiting membrane peeling for MF were studied. Preoperative optical coherence tomography showed that none of the eyes had a macular hole or vitreoretinal traction. Eyes were divided into those with MF and a foveal detachment (FD; FD group, n = 27) and those with MF without an FD (no-FD group, n = 12). The main outcome measures were best-corrected visual acuity (BCVA) and the optical coherence tomography findings. RESULTS Optical coherence tomography showed a complete resolution of the MF with a reattachment of the fovea in all eyes, and the retina remained attached during the mean follow-up of 41 months. The final mean BCVA improved significantly in the FD group (P = 0.0003) but not in the no-FD group (P = 0.56). The final BCVA of the FD group and no-FD group improved in 70% and 42%, remained unchanged in 26% and 33%, and worsened in 4% and 25% of the eyes, respectively. A better final BCVA was significantly correlated with a better preoperative BCVA (P < 0.0001), a shorter axial length (P = 0.045), and the presence of an FD (P = 0.028). CONCLUSION Pars plana vitrectomy with internal limiting membrane peeling results in long-term favorable anatomical and visual outcomes. Eyes with an FD may be good candidates for surgery.

PURPOSE The purpose of this study was to investigate the sensitivity of various scan modes of spectral-domain optical coherence tomography (SD-OCT) for detecting pathologies that may accompany myopic foveoschisis, which is important for making surgical decisions and planning surgical strategies for myopic foveoschisis. METHODS Twenty-one eyes of 18 patients were diagnosed with myopic foveoschisis by SD-OCT. Patients were examined with SD-OCT using both a five-line raster scan and a three-dimensional scan at the same visit. The detection rates of pathologies such as macular hole, epiretinal membrane, retinal vascular microfolds, internal limiting membrane detachment, paravascular microhole, and photoreceptor inner and outer segments defect were compared between modes. RESULTS The three-dimensional scanning mode of the SD-OCT tended to be superior to both the one-line and five-line raster scanning modes for detecting inner and outer segments, epiretinal membrane, macular hole, paravascular microhole, and internal limiting membrane. The three-dimensional mode had a significantly higher detection rate (71%) of retinal vascular microfolds than both the 1-line (19%, P < 0.01) and 5-line raster scanning modes (33%, P < 0.05). CONCLUSION The three-dimensional scan mode of SD-OCT was more sensitive for detecting the pathologies that accompany myopic foveoschisis, providing important information for vitreous surgery.

This is a clinicopathological paper on the histologic findings in myopia-associated macular foveoschisis. The findings on ophthalmic pathological study of a 73-year-old woman with high myopia are reviewed. Multiple retinoschisis cavities involving both the macula and retinal periphery were disclosed. Our paper offers tissue evidence and supports recent ocular coherence tomography reports of eyes with high myopia and associated macular foveoschisis.

The objective of this study was to evaluate the clinical curative effect of posterior scleral reinforcement for macular retinoschisis in highly myopic patients. Twenty-four highly myopic eyes with macular retinoschisis were treated with posterior scleral reinforcement surgery from September 2005 to March 2007 in our hospital. Visual field, best corrected vision acuity (BCVA), refractive error, optical coherence tomography and A/B Scan ultrasound graphy results were retrospectively analysed. The central visual field in 18 eyes was improved after surgery; optical coherence tomography showed complete resolution of the myopic foveoschisis in 20 (83.33%) of the 24 eyes after surgery. The postoperative BCVA was improved by 0.1 or more in 18 eyes (75%), and remained within 0.1 of the preoperative BCVA in five eyes (20.83%) at the end of follow-up. Compared with the preoperative data of 23 eyes, the final magnitude of myopia after surgery was significantly decreased (t = 3.527, P = 0.002). In conclusion, this procedure can effectively treat highly myopic patients with macular retinoschisis without macular hole or retinal detachment, and might be better for maintaining central vision and preventing the occurrence of complications.

Purpose: To report the surgical outcome of pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peeling in three highly myopic patients with macular retinoschisis and associated posterior staphyloma. Methods: We report three highly myopic patients with macular retinoschisis and foveal detachment who underwent simple PPV without ILM peeling, with long-acting gas tamponade. Main outcome evaluations included best corrected visual acuity, biomicroscopic appearance and optical coherence tomography findings. Results: Pars plana vitrectomy without ILM peeling resulted in anatomic and functional improvement in all three operated eyes for follow-up periods of ≥ 12 months. Conclusions: Pars plana vitrectomy without ILM peeling is effective for treating macular retinoschisis and foveal detachment in highly myopic eyes with posterior staphyloma. Visual and anatomic outcomes are comparable with those in previous studies in which ILM removal was performed.

Progress in retinal imaging today allows better detection of intraretinal changes than has ever been possible. Despite the limited definition of time domain OCT, it has greatly improved our understanding of macular diseases, especially of the various kinds of hyporeflective or optically empty spaces in the retina. Spectral domain OCT and ultra-high resolution OCT show the details of abnormal intraretinal structures with even greater precision. However, there is still some ambiguity about differentiating between various macular disorders, whose common feature is the presence of cystoid spaces, probably because we do not completely understand their pathogenesis. The terminology remains influenced by biomicroscopy and fluorescein concepts. Different terms are used to name different conditions which have in common the presence of cystoid spaces, including foveal pseudo cyst, tractional cystoid cavity, occult outer macular hole, cystoid macular edema, tractional macular edema, foveoschisis, and outer retinal cavitation. In this lecture, we would like to point out the limits of our knowledge concerning the pathological intraretinal cavities as they are revealed by OCT.

To investigate the associated factors of foveoschisis and foveal detachment without macular hole in highly myopic eyes. A cross-sectional study of 124 eyes of 68 highly myopic patients was performed. The patients underwent complete ocular examination, fundus photography, and optical coherence tomography (OCT). Of the 124 eyes, 10 (8%, 10/124) had foveoschisis or foveal detachment without a macular hole on OCT examination. On the basis of univariate analysis, six variables were associated with the pathologic changes, including age over 40 years (P=0.018), spherical equivalent over 10 D (P=0.042), axial length over 31 mm (P=0.001), macular chorioretinal atrophy (P=0.00003), posterior staphyloma (P=0.0003), and vitreoretinal interface factors, including epiretinal membrane, posterior vitreoschisis, and vitreomacular traction (P=0.00002). In the multivariate analysis, three factors were independently associated with foveoschisis and foveal detachment without macular hole in high myopia: axial length, macular chorioretinal atrophy, and vitreoretinal interface factors. Foveoschisis and foveal detachment without macular hole are sight-threatening disorders in highly myopic eyes. Axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated with these pathological conditions. Thus, both intraocular and outer ocular wall factors play important roles and merit further study.

Full text: We thank Tsilimbaris et al1 for their comments on the appropriateness of the term ‘myopic foveoschisis’ to describe the condition that is characterized by the separation of neural retina layers associated with high myopia and posterior staphyloma. They have proposed the term ‘myopic ectatic retinopathy’ as a more literal and functionally more accurate descriptor of the condition to avoid the use of the word ‘schisis’, which may be misleading because it is also used to describe other conditions where there is separation of neural retina layers without the presence of staphyloma.2 Using the word ‘ectatic’ for this condition would imply that we are fairly certain about the pathogenesis and mechanistic factors that underlie its development and progression. However, this is not the case, unfortunately, as our review of the literature has shown. There are several theories ranging from vitreous traction to sclerosing changes of retinal vessels to progression of staphylomas as possible etiological factors. Therefore, it is likely to be multifactorial in nature—hence the success reported with different procedures that address either the vitreous traction factor using vitrectomy, peel plus tamponade or the scleral ectasia factor using posterior buckling techniques. In the absence of a good understanding of underlying pathogenesis, it is probably best to use purely descriptive names rather than mechanistic terms. The use of descriptive terms, even though similar, do not necessarily cause confusion as long as they are widely accepted as differentiating terminology, for example, postoperative pseudophakic cystoid macular edema (Irvine–Gass syndrome) vs cystoid macular edema associated with posterior uveitis in a phakic patient. The introduction of too many mechanistic or pathogenetic terms in the absence of clear understating of etiology can in fact cause more confusion, for example, serous chorioretinopathy vs central serous retinopathy vs serous choroidopathy. The confinement to broad descriptive terms can enhance communication and reduce confusion without committing to any presumption about etiology until it is better understood. This approach is probably best illustrated by the recent advances in the understanding of mactel21, a condition initially described and classified, using descriptive nomenclature, by Don Gass as bilateral, idiopathic acquired juxtafoveolar telangiectasis (Group2A) and as distinctly different from unilateral, congenital parafoveolar telangiectasis (Group 1A; Gass,3 pp 504–506 vs 127–128). Finally, it is worthy to note that for myopic foveoschisis associated with a staphyloma that is associated with outer layer macular detachment, Don Gass also descriptively included the additional observation (before the advent of OCT) that the retinal profile was concave rather than convex in shape, thereby differentiating it from rhegmatogenous detachments with recruitment of subretinal fluid that is associated with posteriorly located breaks and macular holes in myopic eyes. References 1.Tsilimbaris MK, Vavvas DG, Bechrakis NE. Myopic foveoschisis: an ectatic retinopathy, not aschisis. Eye 2016; 30: 328–329. 2.Powner MB, Gillies MC, Tretiach M, Scott A, Guymer RH, Hageman GS et al. Perifoveal muller cell depletion in a case of macular telangiectasia type 2. Ophthalmology 2010; 117(12): 2407–2416. 3.Gass DM. Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment, 4th edn. Mosby-Yearbook: St. Louis, 1997.

Summary Purpose To describe the prevalence of macular complications in patients with visual acuity decrease related to high myopia (HM). To establish correlations between these complications and demographic or anatomical characteristics. Materials and methods Cross-sectional observational study including HM patients undergoing best-corrected visual acuity (BCVA), fundus examination, macular SD-OCT, and fluorescein angiography in the case of suspicion of choroidal neovascularization (CNV). The presence of anatomical criteria (staphyloma, subfoveal choroidal thickness [CT]) and macular complications (CNV, lacquer cracks, central chorioretinal atrophy, dome-shaped macula with serous retinal detachment [SRD], retinal foveoschisis, macular hole and epiretinal membrane) was investigated. Results A total of 87 eyes of 47 patients were included (39 eyes without macular complication and 48 eyes with macular complications). In the case of macular complications, decrease in BCVA was related to CNV in 33%, macular hole in 25%, chorioretinal atrophy in 19%, foveoschisis in 11%, lacquer crack in 6%, to a dome-shape macula with serous retinal detachment in 4% and epiretinal membrane in 2%. After adjusting for interocular correlation and degree of myopia, staphyloma ( P = 0.0023), choroidal thinning ( P = 0.0036), and extrafoveal chorioretinal atrophy ( P = 0.042) were significantly associated with macular complications. Conclusions High myopic patients with staphyloma or choroidal thinning should undergo regular comprehensive retinal screening for retinal complications.

Background Myopic foveoschisis is the splitting of retinal layers overlying staphyloma in highly myopic patients that can lead to vision loss. 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 (ROC) measure to track posterior scleral curvature over time. Methods A retrospective, non-comparative case series was performed and optical coherence tomography images were analysed. Retinal pigment epithelial layer ROC was calculated from manually segmented images through the posterior scleral curvature apex. Results Two cases of myopic foveoschisis with foveal detachments in the left eye (OS) were studied. Both patients had high myopia (either 30 mm in axial length). One case occurred in a treatment-naive patient who improved after 4 months of observation. On initial presentation, OS posterior scleral ROC was 12.35 mm and decreased to 12.15 mm at the time of 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 in the interim. Posterior scleral ROC was 4.05 mm on presentation, 4.10 during recurrence, 3.55 mm after cataract extraction and 3.75 mm at resolution. Conclusions Spontaneous improvement of myopic foveoschisis may be due to changes in tractional forces from the internal limiting membrane, cortical vitreous or staphyloma or, alternatively, from a delayed or fluctuant recovery course after intervention.

To describe the anatomical and functional outcomes in a cohort of subjects undergoing vitrectomy for myopic foveoschisis, and to analyse the factors predicting foveal reattachment and visual improvement.This retrospective case series evaluated case records and optical coherence tomography images 6 months after surgery. Multivariate linear and logistic regressions were performed to assess the factors predicting anatomical and visual improvement.In total, 55 eyes of 54 patients were analysed. The mean spherical equivalent refraction was -11.83±4.94D. Foveal detachment was present in 63.5% of eyes preoperatively and subjects with foveal detachment had 0.70 logMAR units (95% CI 0.02 to 1.39) poorer visual acuity than subjects without (p=0.046). The mean preoperative visual acuity was 0.84±0.59 logMAR units and the mean postoperative visual acuity was 0.64±0.64 logMAR units (mean difference 0.20±0.68 logMAR units (p=0.04)). The proportion of eyes with foveal detachment was significantly lower after surgery (12.5%; p0.001). However, the proportion of eyes with ellipsoid zone disruption was significantly higher after surgery (59.6% vs 34.0%; p0.001). In multivariate analyses, the preoperative central foveal thickness significantly predicted postoperative visual improvement by two or more lines (OR 1.004 (95% CI 1.000 to 1.007), per μm increase; p=0.049). The presence of ellipsoid zone disruption preoperatively was associated with 0.96 logMAR (95% CI 0.2 to 1.72) poorer final acuity (p=0.02).Eyes with myopic foveoschisis with preoperative ellipsoid disruption and thinner central foveal thickness tend to have poorer visual outcomes. While current surgical manoeuvres are effective in reattaching the fovea, they may also cause iatrogenic injury to the photoreceptors.

La patología macular traccional constituye una de las principales causas de pérdida de visión severa de los altos miopes. La liberación de las tracciones vítreas y epirretinianas es fundamental para el éxito quirúrgico. La técnica quirúrgica más empleada actualmente es la vitrectomía pars plana con disección de la membrana limitante interna, que ha demostrado ser útil en el tratamiento de la foveosquisis miópica y el desprendimiento de retina por agujero macular. Sin embargo, la presencia de un estafiloma posterior limita estos resultados. Por ello, realizamos un estudio prospectivo, protocolizado e intervencionista con 91 ojos de 87 pacientes para evaluar la eficacia y la seguridad de la indentación macular con indentador de Ando combinada con vitrectomía pars plana y disección de la membrana limitante interna en el tratamiento de la patología traccional del ojo alto miope con estafiloma posterior. Se obtuvo una mejoría significativa de la agudeza visual tanto en el grupo de las foveosquisis miópicas como en los desprendimientos de retina por agujero macular. No se encontraron diferencias respecto a los resultados anatómicos y visuales entre los subgrupos de foveosquisis miópicas (foveosquisis aislada, desprendimiento foveal o agujero macular de espesor completo), obteniéndose el éxito anatómico en todos los casos. La indentación macular obtuvo mejores resultados visuales como técnica de primera elección en los desprendimientos de retina por agujero macular comparado con su uso como técnica de rescate tras una vitrectomía pars plana fracasada. La agudeza visual final fue similar independientemente de la obtención del cierre macular en los casos de desprendimiento de retina por agujero macular. La indentación macular previno la progresión de la foveosquisis a desprendimiento de retina por agujero macular, y la recidiva del desprendimiento de retina aunque el agujero macular permaneciera abierto en el postoperatorio., Traction maculopathy is one of the leading causes of severe vision loss in high myopic eyes. The release of the vitreous and epiretinal traction is critical for surgical success. Pars plana vitrectomy with internal limiting membrane peeling is currently the most widely surgical technique used, which has proven useful in the treatment of myopic foveoschisis and macular hole retina detachment. However, the presence of a posterior staphyloma limits these results. Therefore, we conducted a prospective, interventional with 91 eyes of 87 patients to evaluate the efficacy and safety of macular buckling combined with pars plana vitrectomy and internal limiting membrane peeling. A significant improvement in visual acuity in both myopic foveoschisis group and retinal detachment due to macular hole group was obtained. No differences were found regarding the anatomical and visual results between subgroups of myopic foveoschisis (isolated foveoschisis, foveal detachment or full-thickness macular hole), as we obtained the anatomical success in all cases. Macular buckling obtained better visual results as first choice technique in retinal detachments due to macular hole compared to use as rescue technique after a previous pars plana vitrectomy. Visual acuity was similar irrespective of obtaining macular closure in cases of retinal detachment macular hole. Macular buckling prevented foveoschisis progression to retinal detachment due to macular hole and retinal detachment recurrence although the macular hole remained open after surgery.

High myopia is a clinical condition characterized by a progressive axial elongation of the eye associated with a posterior staphyloma, which leads to an increased risk of specific macular diseases, such as myopic foveoschisis (MF) and macular hole (MH) with or without retinal detachment. Currently, different surgical procedures have been proposed to treat MF, MH, and MHRD in highly myopic patients such as the macular buckling (MB) technique. Several studies in the last decade have shown that the reshaping of the posterior wall by correcting the disproportion between the retina and the elongated sclera provides better results when compared to the outcomes of the patients treated by pars plana vitrectomy (PPV) alone. The common belief that this surgical procedure is technically challenging, mostly due to difficulties related to the correct placement of the buckle and potential risk of damaging adjacent ocular structures, has raised questions concerning the best approach. Therefore, in this chapter we will endeavor to describe why we believe this surgical technique might be the preferred approach for treating patients who have developed the complications of high myopia.

We report a case of a 66-year-old man with a history of high myopia and who was referred for acute decreased visual acuity of the right eye. Fundus examination and optical coherence tomography (OCT) showed a mild epiretinal membrane (ERM) and splitting of retinal layers. Pars plana vitrectomy was performed with intravitreous triamcinolone injection, posterior hyaloid and ERM peeling, and 12% perfluoropropane (C3F8) gas tamponade. After remaining asymptomatic for 17 months, the patient reported a new episode of sudden decreased visual acuity in his right eye, and OCT showed recurrent myopic foveoschisis (MF). He underwent vitrectomy and internal limiting membrane (ILM) peeling. Six months later, the patient's best corrected visual acuity had improved to 20/25. Optical coherence tomography showed a remarkably improved macular anatomy, with residual traction along the inferotemporal arcade, which was attributed to the vessel stiffness itself. We conclude that removing the internal limiting membrane is a challenging maneuver in myopic foveoschisis, even with staining approaches. Although myopic foveoschisis may be resolved without peeling the internal limiting membrane, its removal should be considered if the condition recurs.

Purpose. To report the morphological and functional changes associated with a regression of foveoschisis in a patient with X-linked retinoschisis (XLRS).Methods. A 42-year-old man with XLRS underwent genetic analysis and detailed ophthalmic examinations. Functional assessments included best-corrected visual acuity (BCVA), full-field electroretinograms (ERGs), and multifocal ERGs (mfERGs). Morphological assessments included fundus photography, spectral-domain optical coherence tomography (SD-OCT), and adaptive optics (AO) fundus imaging. After the baseline clinical data were obtained, topical dorzolamide was applied to the patient. The patient was followed for 24 months.Results. A reportedRS1gene mutation was found (P203L) in the patient. At the baseline, his decimal BCVA was 0.15 in the right and 0.3 in the left eye. Fundus photographs showed bilateral spoke wheel-appearing maculopathy. SD-OCT confirmed the foveoschisis in the left eye. The AO images of the left eye showed spoke wheel retinal folds, and the folds were thinner than those in fundus photographs. During the follow-up period, the foveal thickness in the SD-OCT images and the number of retinal folds in the AO images were reduced.Conclusions. We have presented the detailed morphological changes of foveoschisis in a patient with XLRS detected by SD-OCT and AO fundus camera. However, the findings do not indicate whether the changes were influenced by topical dorzolamide or the natural history.

To evaluate the efficacy of vitrectomy for posterior retinoschisis (RS) or foveal detachment (FD) associated with posterior staphyloma in myopic eyes. We reviewed the records of 14 consecutive patients (53–77 years of age; 16 eyes) with progressive visual impairment as a result of myopic RS or FD. Optical coherence tomography demonstrated the presence of a variety of RS and FD characteristics. Five eyes had RS alone, and 11 eyes had RS and FD. Two eyes with RS and severe FD developed retinal detachment in conjunction with a tiny macular hole. Vitrectomy, including posterior vitreous separation in all eyes and internal limiting membrane (ILM) peeling in six eyes, had been performed. The patients were followed postoperatively for 6 to 66 months (mean, 24 months). The anatomical outcome and visual acuity were retrospectively analyzed in this study. Although the two eyes with RS and severe FD developed retinal detachment with a macular hole after an initial vitrectomy, final retinal reattachment was achieved in all 16 eyes. Visual acuity improved in nine eyes and remained unchanged in seven eyes. Vitrectomy with posterior vitreous separation is effective for reattaching the macula and preventing a deterioration of vision, although eyes with RS and severe FD may be at risk for the development of a macular hole after the initial vitrectomy. Jpn J Ophthalmol 2006;50:53–61 © Japanese Ophthalmological Society 2006

Purpose We performed vitrectomy on two eyes for persistent myopic foveoschisis (MF) after primary surgery that did not include internal limiting membrane (ILM) peeling. Design Interventional case reports. Methods Two highly myopic eyes of two patients with persistent MF after primary vitrectomy and gas tamponade but without ILM peeling were treated with pars plana vitrectomy, residual vitreous cortex removal, ILM peeling, and long-term gas tamponade. Results Total foveal reattachment was achieved and best-corrected visual acuity (BCVA) improved in both eyes. Conclusions Reoperation including complete vitreous cortex removal and ILM peeling could be beneficial for patients with persistent MF after primary surgery, indicating that vitreous cortex removal and ILM peeling are critical in treating MF.

Aim: To evaluate the clinical and anatomical outcomes of pars plana vitrectomy and gas tamponade without internal limiting membrane (ILM) peeling in symptomatic patients caused by myopic foveoschisis. Methods: Nine eyes in eight highly myopic patients who had myopic foveoschisis with foveal detachment underwent vitrectomy without ILM peeling followed by gas tamponade. Main outcome measures include change in best corrected visual acuity (BCVA) and changes in height of the foveal detachment and resolution of the myopic foveoschisis measured by optical coherence tomography (OCT). Results: After surgery, BCVA improved in eight eyes with the median BCVA improved from 20/80 to 20/50 (p = 0.012). The mean line of visual improvement was 3.6 lines. OCT showed complete resolution of myopic foveoschisis with complete foveal reattachment in seven (77.8%) eyes with partial resolution in two (22.2%) eyes. The mean height of foveal detachment decreased from 505 μm preoperatively to 21 μm postoperatively (p Conclusions: Vitrectomy without ILM peeling followed by gas tamponade appeared to result in favourable visual and anatomical outcomes for treating myopic foveoschisis in highly myopic eyes. The results are comparable with studies in which ILM removal was performed. Further controlled study will be useful to determine the role of ILM peeling in these patients.