High myopic patients with and without foveoschisis: morphological and functional characteristics

Postoperative Outcomes and Prognostic Factors of High Myopia-Epiretinal Membrane Associated with Retinoschisis after Vitrectomy

INTRODUCTION

The outcomes and prognosis of pars plana vitrectomy (PPV) for high myopia-epiretinal membrane (HM-ERM) patients with retinoschisis remains unclear. The aim of this study was to analyze the impact of retinoschisis on the recovery of macular configuration and visual acuity following ERM removal in eyes with HM and to explore the prognostic factors.

METHODS

A retrospective study of 73 consecutive patients with HM-ERM who underwent PPV with ERM peeling. According to the optical coherence tomography images, eyes were classified into 4 groups: group A without retinoschisis, group B with outer retinoschisis, group C with inner retinoschisis, and group D with both inner and outer retinoschisis.

RESULTS

In groups A, B, C, and D, there were 17, 21, 22, and 16 eyes, respectively. Retinoschisis of 44 eyes (74.6%) disappeared postoperatively, including 11 eyes in group B, 20 in group C, and 8 in group D. No correlation was found between retinoschisis resolution and baseline factors. The mean best corrected visual acuity (BCVA) significantly improved at the final follow-up (p < 0.001). The final BCVA was associated with baseline BCVA (p = 0.001), the presence of epiretinal proliferation preoperatively (p = 0.014), and the postoperative integrity of the ellipsoid zone (EZ) (p = 0.001) and interdigitation zone (IZ) (p = 0.008).

CONCLUSIONS

After surgery, the inner retinoschisis usually resolved completely. Retinoschisis was not the main factor influencing final BCVA. Preoperative BCVA and disruption of EZ and IZ were associated with good visual recovery in long-term follow-up.

The effect of intraocular lens and lens eye on the treatment of macular splits in high myopia

BACKGROUND

Macular retinoschisis in patients with high myopia is one of the main reasons for a decline in visual function and the perceived deformation of visual objects.

OBJECTIVE

This study aimed to investigate the therapeutic effect of cataract phacoemulsification and foldable intraocular lens implantation (FILI) combined with internal limiting membrane stripping (ILMS) in the treatment of macular retinoschisis in patients with high myopia.

METHODS

A total of 52 patients (55 eyes) who had been diagnosed with macular retinoschisis with high myopia between June 2019 and June 2020 were enrolled in the present study. Patients in the control group (25 eyes) received 23G vitreous surgery and macular ILMS and long-term inert gas (C3F8) filling of the vitreous cavity; patients in the research group (30 eyes) were additionally treated with cataract phacoemulsification and soft intraocular lens on the same treatment basis as the control group.

RESULTS

The difference in average BCVA between the control and the research groups was not statistically significant before the surgery (P> 0.05) but was statistically significant 12 months after the procedure (P< 0.05). The minimum foveal thickness was significantly decreased in the two groups after the surgery compared with before the procedure (P< 0.05).

CONCLUSION

Cataract phacoemulsification and FILI further improved the therapeutic effect of ILMS in the treatment of macular retinoschisis in patients with high myopia.

Association of Retinal Sensitivity With Optical Coherence Tomography Microstructure in Highly Myopic Patients

Purpose

To investigate the association of retinal sensitivity with microstructural features in optical coherence tomography (OCT) of high myopic eyes.

Methods

This cross-sectional study included 78 eyes (78 patients). Microstructural features on spectral-domain OCT, such as the integrity of the retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) and outer retinoschisis, were evaluated at each retinal location corresponding to microperimetric testing points.

Results

For all testing points, retinal sensitivity was significantly associated with the integrity of the RPE, EZ, and ELM (all P < 0.001) based on OCT but not with outer retinoschisis (P = 0.183). A higher category of myopic maculopathy according to the Meta-Analysis of Pathologic Myopia classification was associated with lower mean retinal sensitivity (P < 0.001). In eyes with patchy atrophy (PA), mean retinal sensitivity of testing points adjacent to the PA lesion (15.7 ± 6.8 dB) was greater than points within or at the PA border (2.6 ± 5.2 dB; P < 0.001) but lower than distant points (19.6 ± 4.3 dB; P < 0.001). Microstructural features in OCT were well correlated with the differences in retinal sensitivity according to myopic maculopathy severity and proximity to the PA lesion.

Conclusions

In highly myopic eyes, retinal sensitivity on microperimetry was strongly associated with microstructural features in OCT. Both retinal sensitivity and microstructure were affected by the severity of myopic degeneration and proximity to the PA lesion.

Electroretinogram responses in myopia: a review

The stretching of a myopic eye is associated with several structural and functional changes in the retina and posterior segment of the eye. Recent research highlights the role of retinal signaling in ocular growth. Evidence from studies conducted on animal models and humans suggests that visual mechanisms regulating refractive development are primarily localized at the retina and that the visual signals from the retinal periphery are also critical for visually guided eye growth. Therefore, it is important to study the structural and functional changes in the retina in relation to refractive errors. This review will specifically focus on electroretinogram (ERG) changes in myopia and their implications in understanding the nature of retinal functioning in myopic eyes. Based on the available literature, we will discuss the fundamentals of retinal neurophysiology in the regulation of vision-dependent ocular growth, findings from various studies that investigated global and localized retinal functions in myopia using various types of ERGs.