Myopic Foveoschisis Completely Resolves within 12 Months after Vitrectomy

Customized treatment for myopic traction maculopathy based on the MTM staging system: Long-term results in naïve eyes

PurposeTo explore the long-term anatomical and functional outcomes in naïve patients with Myopic Traction Maculopathy (MTM) treated with either macular buckle (MB) plus pars plana vitrectomy (PPV) or primary MB as unique treatment according to MTM Staging System (MSS).MethodsRetrospective study involving 206 consecutive naïve patients with MTM who underwent either MB plus PPV or primary MB. Postoperative anatomical and functional outcomes, including the MTM stage and its progression, axial length (AL), and best-corrected visual acuity (BCVA) changes, were evaluated at one month (i.e., "early follow-up"), six months (i.e., intermediate follow-up"), 12 months postoperatively (i.e., "late follow-up") and at last follow-up ranging between 12 and 156 months postoperatively (i.e., "final follow-up").ResultsRetinal and foveal anatomical results significantly improved in patients who underwent either primary MB plus PPV or MB (p < 0.001), with 100% and 92.1% of patients who underwent complete resolution, respectively. For every MTM stage, the BCVA significantly improved over the follow-up visits. (p < 0.001). At the last visit, 84 (41%) eyes improved to 0.5 decimal or more. In patients treated before 2020, when applying more combined PPV treatments, there was a high rate of early iatrogenic full-thickness macular holes (p = 0.005). The results obtained since 2020, when the customized treatment was employed, led to better results without sight-threatening complications.ConclusionsThe MTM Staging System should be the foundation for treating MTM. It should precisely assess the optimal surgical technique and the ideal time to perform it concerning the various stages to maximize anatomical and functional success.

Diameter of cystoid spaces and choroidal hypertransmission as novel prognostic biomarkers in myopic foveoschisis

PURPOSE

To analyse optical coherence tomography (OCT) biomarkers of anatomical and functional success in myopic foveoschisis (MF) (stage I and II of ATN classification) undergoing pars plana vitrectomy (PPV).

MATERIALS AND METHODS

Isolated MF cases who underwent PPV showing preoperative optical coherence tomography (OCT)-documented integrity of the foveal ellipsoid zone (EZ) and retinal pigmented epithelium (RPE) were included. Availability of good quality preoperative and 1-year-postoperative OCT acquisitions was also mandatory for inclusion. Anatomical success was defined as persistence of <20% of preoperative cystoid spaces within the parafoveal region and preservation of the foveal EZ and RPE. Functional success was defined as postoperative improvement of at least 10 ETDRS letters.

RESULTS

Anatomical success was obtained in 86.1% cases (31/36). A significantly higher prevalence of preoperative choroidal hypertransmission (CH) with preserved EZ and RPE was detected in the anatomical failure group. Functional success was reported in 72.2% of cases. A larger diameter of preoperative foveal cysts and the presence of a cotton ball sign were associated with a worse functional outcome. Dome shaped macula (DMS) was associated to a good anatomical and functional outcome.

CONCLUSIONS

Our retrospective analysis highlighted that the preoperative presence of a foveal CH with preserved foveal EZ and RPE might be predictive a postoperative anatomical and functional failure in MF surgery. By contrast, a larger diameter of foveal cysts might be associated to functional failure despite anatomical success, while DMS might be a predictor of good prognosis. Assessment of the described biomarkers on a larger prospective cohort is needed to validate our findings.

Retinal and Vitreous Changes Associated with Spontaneous Improvement in Myopic Macular Schisis

PURPOSE

To describe the retinal and vitreous changes in eyes showing myopic macular schisis (MMS) improvement when vitrectomy was not performed and identify triggering factors.

DESIGN

Retrospective observational study.

SUBJECTS

Patients with nonoperated MMS.

METHODS

The records of patients with MMS who were followed without performing surgery for >6 months were retrospectively reviewed, and the eyes showing an anatomic improvement were included. Myopic macular schisis evolution was analyzed quantitatively (central foveal thickness [CFT], parafoveal thickness, maximum height) and qualitatively (presence/absence of foveal detachment, lamellar hole, epiretinal membrane, choroidal neovascularization, inner and outer retinoschisis, vitreous status) at baseline and at the final visit. An anatomic improvement was defined as a decrease in CFT by ≥50 μm.

MAIN OUTCOME MEASURES

The rate of anatomic improvement of MMS without performing vitrectomy and the morphological changes observed in these cases.

RESULTS

In a cohort of 74 nonoperated eyes with MMS, MMS improved in 14 eyes (19%) after a mean follow-up of 55 ± 38 months (range, 8-138). In these improved cases, the mean decrease in CFT was 153 ± 166 μm (range, 24-635; P = 0.005) and a complete resolution of MMS was observed in 9 eyes (64%). In 9 eyes (64%), the improvement was associated with visible vitreous changes in the macular area on the OCT scans. The mean visual acuity, which was already good at baseline (20/50, 0.4 ± 0.2 logarithm of the minimum angle of resolution), increased at the last visit (20/40, 0.3 ± 0.3 logarithm of the minimum angle of resolution) but without reaching significance.

CONCLUSIONS

This long-term follow-up analysis showed that almost 20% of MMS in eyes without indication for surgery could improve over time. In most cases, the improvement was associated with an apparent resolution of vitreous tensions.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Efficacy of Vitrectomy With Tamponade Versus No Tamponade for Myopic Traction Maculopathy: A Multicenter Study (SCHISIS Report No.1)

PURPOSE

To evaluate the influence of tamponade on the visual and anatomic outcomes of pars plana vitrectomy for myopic traction maculopathy (MTM).

DESIGN

Multicenter, retrospective clinical cohort study.

METHODS

Consecutive eyes that underwent vitrectomy for advanced MTM with tamponade of air, sulfur hexafluoride (SF6), or perfluoropropane (C3F8) or without tamponade with a minimum follow-up of 12 months were included. Main outcome measures included postoperative visual acuity (VA) at 12 months in eyes with vs without tamponade.

RESULTS

We included a total of 193 eyes (193 patients) in this study; 136 eyes (70%) treated with tamponade were compared with 57 eyes (30%) treated without tamponade. Baseline characteristics did not differ significantly between the groups. Both groups showed significant visual improvement at 12 months (both P < .001). However, postoperative visual acuity and visual improvement at 12 months were significantly better (P = .003 and P = .028, respectively) in eyes without tamponade, although the MTM in these eyes without tamponade took longer to resolve (P = .039). Retinal thickness and the ellipsoid zone were more preserved in eyes without tamponade (P < .001 and P = .001, respectively). Complications such as macular holes did not differ between the groups. A novel imaging finding of "schisis bending (accordioning)" was identified during MTM resolution.

CONCLUSIONS

Vitrectomy either with or without tamponade for MTM was effective in improving vision in this study. However, eyes without tamponade experienced even better visual improvement and preserved retinal anatomy, despite a longer schisis resolution time. Surgery without tamponade may achieve better visual outcomes.

Non-vasogenic cystoid maculopathies

Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.