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03-02-2025 | Peeling | Clinical Investigation

Surgical outcomes of non-fovea-sparing internal limiting membrane peeling using a double-staining technique for symptomatic myopic foveoschisis: a retrospective study

Authors: Tadashi Mizuguchi, Masayuki Horiguchi, Atsuhiro Tanikawa, Yasuki Ito

Published in: Japanese Journal of Ophthalmology

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Abstract

Purpose

To investigate the incidence of postoperative macular hole (MH), visual acuity, and anatomical recovery in patients who underwent a non-fovea-sparing technique using a double-staining method for symptomatic myopic foveoschisis without pre-existing macular holes.

Study design

A retrospective study.

Methods

We evaluated 39 eyes from 39 consecutive patients diagnosed with myopic foveoschisis from May 2017 to September 2022 at Fujita Health University Hospital. All patients underwent non-fovea-sparing internal limiting membrane peeling using a double-staining method and were monitored for 6 months postoperatively. Best-corrected visual acuity (BCVA) as measured by the logarithm of the minimum angle of resolution (logMAR), central retinal thickness (CRT), and the presence of foveoschisis were assessed using optical coherence tomography (OCT) preoperatively (pre) and at 1 month (1 M), 3 months (3 M), and 6 months (6 M) postoperatively.

Results

No cases of postoperative rhegmatogenous retinal detachment were observed. A postoperative MH developed in one eye. The mean logMAR values at pre, 1 M, 3 M, and 6 M were 0.38 ± 0.37, 0.23 ± 0.33, 0.18 ± 0.25, and 0.13 ± 0.29, respectively (all P < 0.001). The mean CRTs at pre, 1 M, 3 M, and 6 M were 384.6 ± 177.2, 262.2 ± 84.4, 200.3 ± 64.9, and 185.6 ± 61.0 μm, respectively (all P < 0.001). Foveoschisis was observed in all 39 eyes (100%) preoperatively and in 17 eyes (43.6%) at 1 M, nine eyes (34.6%) at 3 M, and zero eyes (0%) at 6 M postoperatively.

Conclusion

The non-fovea-sparing double-staining technique was effective in treating myopic foveoschisis without MH, leading to significant improvements in both visual function and anatomical recovery. This method may be a promising surgical option for managing myopic foveoschisis.
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Literature
1.
go back to reference Baba T, Ohno-Matsui K, Futagami S, Yoshida T, Yasuzumi K, Kojima A, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia. Am J Ophthalmol. 2003;135:338–42.PubMedCrossRef Baba T, Ohno-Matsui K, Futagami S, Yoshida T, Yasuzumi K, Kojima A, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia. Am J Ophthalmol. 2003;135:338–42.PubMedCrossRef
2.
go back to reference Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma. Am J Ophthalmol. 1999;128:472–6.PubMedCrossRef Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma. Am J Ophthalmol. 1999;128:472–6.PubMedCrossRef
3.
go back to reference Bando H, Ikuno Y, Choi JS, Tano Y, Yamanaka I, Ishibashi T. Ultrastructure of internal limiting membrane in myopic foveoschisis. Am J Ophthalmol. 2005;139:197–9.PubMedCrossRef Bando H, Ikuno Y, Choi JS, Tano Y, Yamanaka I, Ishibashi T. Ultrastructure of internal limiting membrane in myopic foveoschisis. Am J Ophthalmol. 2005;139:197–9.PubMedCrossRef
4.
go back to reference Gaucher D, Haouchine B, Tadayoni R, Massin P, Erginay A, Benhamou N, et al. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome. Am J Ophthalmol. 2007;143:455–62.PubMedCrossRef Gaucher D, Haouchine B, Tadayoni R, Massin P, Erginay A, Benhamou N, et al. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome. Am J Ophthalmol. 2007;143:455–62.PubMedCrossRef
5.
go back to reference Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis. Am J Ophthalmol. 2005;139:462–7.PubMedCrossRef Ikuno Y, Gomi F, Tano Y. Potent retinal arteriolar traction as a possible cause of myopic foveoschisis. Am J Ophthalmol. 2005;139:462–7.PubMedCrossRef
6.
go back to reference Matsumura N, Ikuno Y, Tano Y. Posterior vitreous detachment and macular hole formation in myopic foveoschisis. Am J Ophthalmol. 2004;138:1071–3.PubMedCrossRef Matsumura N, Ikuno Y, Tano Y. Posterior vitreous detachment and macular hole formation in myopic foveoschisis. Am J Ophthalmol. 2004;138:1071–3.PubMedCrossRef
7.
go back to reference Polito A, Lanzetta P, Del Borrello M, Bandello F. Spontaneous resolution of a shallow detachment of the macula in a highly myopic eye. Am J Ophthalmol. 2003;135:546–7.PubMedCrossRef Polito A, Lanzetta P, Del Borrello M, Bandello F. Spontaneous resolution of a shallow detachment of the macula in a highly myopic eye. Am J Ophthalmol. 2003;135:546–7.PubMedCrossRef
8.
go back to reference Sayanagi K, Ikuno Y, Gomi F, Tano Y. Retinal vascular microfolds in highly myopic eyes. Am J Ophthalmol. 2005;139:658–63.PubMedCrossRef Sayanagi K, Ikuno Y, Gomi F, Tano Y. Retinal vascular microfolds in highly myopic eyes. Am J Ophthalmol. 2005;139:658–63.PubMedCrossRef
9.
go back to reference Sayanagi K, Ikuno Y, Tano Y. Reoperation for persistent myopic foveoschisis after primary vitrectomy. Am J Ophthalmol. 2006;141:414–7.PubMedCrossRef Sayanagi K, Ikuno Y, Tano Y. Reoperation for persistent myopic foveoschisis after primary vitrectomy. Am J Ophthalmol. 2006;141:414–7.PubMedCrossRef
10.
go back to reference Shimada N, Ohno-Matsui K, Baba T, Futagami S, Tokoro T, Mochizuki M. Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment. Am J Ophthalmol. 2006;142:497–500.PubMedCrossRef Shimada N, Ohno-Matsui K, Baba T, Futagami S, Tokoro T, Mochizuki M. Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment. Am J Ophthalmol. 2006;142:497–500.PubMedCrossRef
11.
go back to reference Johnson MW. Myopic traction maculopathy: pathogenic mechanisms and surgical treatment. Retina. 2012;32(Suppl 2):S205–10.PubMedCrossRef Johnson MW. Myopic traction maculopathy: pathogenic mechanisms and surgical treatment. Retina. 2012;32(Suppl 2):S205–10.PubMedCrossRef
12.
go back to reference Vanderbeek BL, Johnson MW. The diversity of traction mechanisms in myopic traction maculopathy. Am J Ophthalmol. 2012;153:93–102.PubMedCrossRef Vanderbeek BL, Johnson MW. The diversity of traction mechanisms in myopic traction maculopathy. Am J Ophthalmol. 2012;153:93–102.PubMedCrossRef
13.
go back to reference Hwang JU, Joe SG, Lee JY, Kim JG, Yoon YH. Microincision vitrectomy surgery for myopic foveoschisis. Br J Ophthalmol. 2013;97:879–84.PubMedCrossRef Hwang JU, Joe SG, Lee JY, Kim JG, Yoon YH. Microincision vitrectomy surgery for myopic foveoschisis. Br J Ophthalmol. 2013;97:879–84.PubMedCrossRef
14.
go back to reference Ikuno Y, Sayanagi K, Ohji M, Kamei M, Gomi F, Harino S, et al. Vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Am J Ophthalmol. 2004;137:719–24.PubMed Ikuno Y, Sayanagi K, Ohji M, Kamei M, Gomi F, Harino S, et al. Vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Am J Ophthalmol. 2004;137:719–24.PubMed
15.
go back to reference Ikuno Y, Sayanagi K, Soga K, Oshima Y, Ohji M, Tano Y. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis. Jpn J Ophthalmol. 2008;52:269–76.PubMedCrossRef Ikuno Y, Sayanagi K, Soga K, Oshima Y, Ohji M, Tano Y. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis. Jpn J Ophthalmol. 2008;52:269–76.PubMedCrossRef
16.
go back to reference Kanda S, Uemura A, Sakamoto Y, Kita H. Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes. Am J Ophthalmol. 2003;136:177–80.PubMedCrossRef Kanda S, Uemura A, Sakamoto Y, Kita H. Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes. Am J Ophthalmol. 2003;136:177–80.PubMedCrossRef
17.
go back to reference Kobayashi H, Kishi S. Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. Ophthalmology. 2003;110:1702–7.PubMedCrossRef Kobayashi H, Kishi S. Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. Ophthalmology. 2003;110:1702–7.PubMedCrossRef
18.
go back to reference Shin JY, Yu HG. Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy. Retina. 2012;32:486–92.PubMedCrossRef Shin JY, Yu HG. Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy. Retina. 2012;32:486–92.PubMedCrossRef
19.
go back to reference Futagami S, Inoue M, Hirakata A. Removal of internal limiting membrane for recurrent myopic traction maculopathy. Clin Exp Ophthalmol. 2008;36:782–5.PubMedCrossRef Futagami S, Inoue M, Hirakata A. Removal of internal limiting membrane for recurrent myopic traction maculopathy. Clin Exp Ophthalmol. 2008;36:782–5.PubMedCrossRef
20.
go back to reference Kuhn F. Internal limiting membrane removal for macular detachment in highly myopic eyes. Am J Ophthalmol. 2003;135:547–9.PubMedCrossRef Kuhn F. Internal limiting membrane removal for macular detachment in highly myopic eyes. Am J Ophthalmol. 2003;135:547–9.PubMedCrossRef
21.
go back to reference Zheng B, Chen Y, Chen Y, Zhao Z, Zhang Z, Zheng J, et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis. Retina. 2011;31:692–701.PubMedCrossRef Zheng B, Chen Y, Chen Y, Zhao Z, Zhang Z, Zheng J, et al. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis. Retina. 2011;31:692–701.PubMedCrossRef
22.
go back to reference Hirakata A, Hida T. Vitrectomy for myopic posterior retinoschisis or foveal detachment. Jpn J Ophthalmol. 2006;50:53–61.PubMedCrossRef Hirakata A, Hida T. Vitrectomy for myopic posterior retinoschisis or foveal detachment. Jpn J Ophthalmol. 2006;50:53–61.PubMedCrossRef
23.
go back to reference Shimada N, Sugamoto Y, Ogawa M, Takase H, Ohno-Matsui K. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol. 2012;154:693–701.PubMedCrossRef Shimada N, Sugamoto Y, Ogawa M, Takase H, Ohno-Matsui K. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol. 2012;154:693–701.PubMedCrossRef
24.
go back to reference Ho TC, Chen MS, Huang JS, Shih YF, Ho H, Huang YH. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery. Retina. 2012;32:631–4.PubMed Ho TC, Chen MS, Huang JS, Shih YF, Ho H, Huang YH. Foveola nonpeeling technique in internal limiting membrane peeling of myopic foveoschisis surgery. Retina. 2012;32:631–4.PubMed
25.
go back to reference Al-Badawi AH, Abdelhakim MASE, Macky TA, Mortada HA. Efficacy of non-fovea-sparing ILM peeling for symptomatic myopic foveoschisis with and without macular hole. Br J Ophthalmol. 2019;103:257–63.PubMedCrossRef Al-Badawi AH, Abdelhakim MASE, Macky TA, Mortada HA. Efficacy of non-fovea-sparing ILM peeling for symptomatic myopic foveoschisis with and without macular hole. Br J Ophthalmol. 2019;103:257–63.PubMedCrossRef
26.
go back to reference Peng KL, Kung YH, Hsu CM, Chang SP, Tseng PL, Wu TT. Surgical outcomes of centripetal non-fovea-sparing internal limiting membrane peeling for myopic foveoschisis with and without foveal detachment: a follow-up of at least 3 years. Br J Ophthalmol. 2020;104:1266–70.PubMedCrossRef Peng KL, Kung YH, Hsu CM, Chang SP, Tseng PL, Wu TT. Surgical outcomes of centripetal non-fovea-sparing internal limiting membrane peeling for myopic foveoschisis with and without foveal detachment: a follow-up of at least 3 years. Br J Ophthalmol. 2020;104:1266–70.PubMedCrossRef
27.
go back to reference Kakehi S, Mizuguchi T, Tanikawa A, Horiguchi M. Modified inverted internal limiting membrane flap technique for macular hole closure. Jpn J Ophthalmol. 2022;66:543–8.PubMedCrossRef Kakehi S, Mizuguchi T, Tanikawa A, Horiguchi M. Modified inverted internal limiting membrane flap technique for macular hole closure. Jpn J Ophthalmol. 2022;66:543–8.PubMedCrossRef
28.
go back to reference Azuma K, Hirasawa K, Araki F, Shiraya T, Yashiro S, Kato S, et al. Fovea-sparing as opposed to total peeling of internal limiting membrane for myopic foveoschisis: a systematic review and meta-analysis. Ophthalmol Retina. 2021;5:670–9.PubMedCrossRef Azuma K, Hirasawa K, Araki F, Shiraya T, Yashiro S, Kato S, et al. Fovea-sparing as opposed to total peeling of internal limiting membrane for myopic foveoschisis: a systematic review and meta-analysis. Ophthalmol Retina. 2021;5:670–9.PubMedCrossRef
29.
go back to reference Wang Y, Zhao X, Zhang W, Yang J, Chen Y. Fovea-sparing versus complete internal limiting membrane peeling in vitrectomy for vitreomacular interface diseases: a systematic review and meta-analysis. Retina. 2021;41:1143–52.PubMedPubMedCentralCrossRef Wang Y, Zhao X, Zhang W, Yang J, Chen Y. Fovea-sparing versus complete internal limiting membrane peeling in vitrectomy for vitreomacular interface diseases: a systematic review and meta-analysis. Retina. 2021;41:1143–52.PubMedPubMedCentralCrossRef
30.
go back to reference Chen G, Mao S, Tong Y, Jiang F, Yang J, Li W. Fovea sparing versus complete internal limiting membrane peeling for myopic traction maculopathy: a meta-analysis. Int Ophthalmol. 2022;42:765–73.PubMedCrossRef Chen G, Mao S, Tong Y, Jiang F, Yang J, Li W. Fovea sparing versus complete internal limiting membrane peeling for myopic traction maculopathy: a meta-analysis. Int Ophthalmol. 2022;42:765–73.PubMedCrossRef
31.
go back to reference Uchiyama H, Nogami S, Katayama K, Hayashi K, Kadota K, Tozuka Y. Jelly containing composite based on α-glucosyl stevia and polyvinylpyrrolidone: improved dissolution property of curcumin. Eur J Pharm Sci. 2018;117:48–54.PubMedCrossRef Uchiyama H, Nogami S, Katayama K, Hayashi K, Kadota K, Tozuka Y. Jelly containing composite based on α-glucosyl stevia and polyvinylpyrrolidone: improved dissolution property of curcumin. Eur J Pharm Sci. 2018;117:48–54.PubMedCrossRef
32.
go back to reference Wang L, Wang Y, Li Y, Yan Z, Li Y, Lu L, et al. Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis. Med (Baltim). 2019;98:e14710.CrossRef Wang L, Wang Y, Li Y, Yan Z, Li Y, Lu L, et al. Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis. Med (Baltim). 2019;98:e14710.CrossRef
33.
go back to reference Itoh Y, Inoue M, Kato Y, Koto T, Hirakata A. Alterations of foveal architecture during vitrectomy for myopic retinoschisis identified by intraoperative optical coherence tomography. Ophthalmologica. 2019;242:87–97.PubMedCrossRef Itoh Y, Inoue M, Kato Y, Koto T, Hirakata A. Alterations of foveal architecture during vitrectomy for myopic retinoschisis identified by intraoperative optical coherence tomography. Ophthalmologica. 2019;242:87–97.PubMedCrossRef
34.
go back to reference Elwan MM, Abd Elghafar AE, Hagras SM, Abou Samra WA, Saleh SM. Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis. Eur J Ophthalmol. 2019;29:69–74.PubMedCrossRef Elwan MM, Abd Elghafar AE, Hagras SM, Abou Samra WA, Saleh SM. Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis. Eur J Ophthalmol. 2019;29:69–74.PubMedCrossRef
35.
go back to reference Iwasaki M, Miyamoto H, Okushiba U, Imaizumi H. Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy. Jpn J Ophthalmol. 2020;64:13–21.PubMedCrossRef Iwasaki M, Miyamoto H, Okushiba U, Imaizumi H. Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy. Jpn J Ophthalmol. 2020;64:13–21.PubMedCrossRef
36.
go back to reference Russo A, Morescalchi F, Gambicorti E, Cancarini A, Costagliola C, Semeraro F. Epiretinal membrane removal with foveal-sparing internal limiting membrane peeling: a pilot study. Retina. 2019;39:2116–24.PubMedCrossRef Russo A, Morescalchi F, Gambicorti E, Cancarini A, Costagliola C, Semeraro F. Epiretinal membrane removal with foveal-sparing internal limiting membrane peeling: a pilot study. Retina. 2019;39:2116–24.PubMedCrossRef
37.
go back to reference Kim KS, Lee SB, Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis. Am J Ophthalmol. 2012;153:320–e3261.PubMedCrossRef Kim KS, Lee SB, Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis. Am J Ophthalmol. 2012;153:320–e3261.PubMedCrossRef
38.
go back to reference Gao X, Ikuno Y, Fujimoto S, Nishida K. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis. Am J Ophthalmol. 2013;155:1021–e10271.PubMedCrossRef Gao X, Ikuno Y, Fujimoto S, Nishida K. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis. Am J Ophthalmol. 2013;155:1021–e10271.PubMedCrossRef
39.
go back to reference Lim SJ, Kwon YH, Kim SH, You YS, Kwon OW. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis. Graefes Arch Clin Exp Ophthalmol. 2012;250:1573–7.PubMedCrossRef Lim SJ, Kwon YH, Kim SH, You YS, Kwon OW. Vitrectomy and internal limiting membrane peeling without gas tamponade for myopic foveoschisis. Graefes Arch Clin Exp Ophthalmol. 2012;250:1573–7.PubMedCrossRef
40.
go back to reference Benhamou N, Massin P, Haouchine B, Erginay A, Gaudric A. Macular retinoschisis in highly myopic eyes. Am J Ophthalmol. 2002;133:794–800.PubMedCrossRef Benhamou N, Massin P, Haouchine B, Erginay A, Gaudric A. Macular retinoschisis in highly myopic eyes. Am J Ophthalmol. 2002;133:794–800.PubMedCrossRef
41.
go back to reference Uchida A, Shinoda H, Koto T, Mochimaru H, Nagai N, Tsubota K, et al. Vitrectomy for myopic foveoschisis with internal limiting membrane peeling and no gas tamponade. Retina. 2014;34:455–60.PubMedCrossRef Uchida A, Shinoda H, Koto T, Mochimaru H, Nagai N, Tsubota K, et al. Vitrectomy for myopic foveoschisis with internal limiting membrane peeling and no gas tamponade. Retina. 2014;34:455–60.PubMedCrossRef
42.
go back to reference Zhang T, Zhu Y, Jiang CH, Xu GZ. Long-term follow-up of vitrectomy in patients with pathologic myopic foveoschisis. Int J Ophthalmol. 2017;10:277–84.PubMedPubMedCentral Zhang T, Zhu Y, Jiang CH, Xu GZ. Long-term follow-up of vitrectomy in patients with pathologic myopic foveoschisis. Int J Ophthalmol. 2017;10:277–84.PubMedPubMedCentral
43.
go back to reference Feng J, Shao Q, Xie J, Yu J, Li M, Liu C, et al. Comparison of three internal limiting membrane peeling techniques for myopic traction maculopathy with high risk of postoperative macular hole development. Retina. 2023;43:1872–80.PubMedPubMedCentral Feng J, Shao Q, Xie J, Yu J, Li M, Liu C, et al. Comparison of three internal limiting membrane peeling techniques for myopic traction maculopathy with high risk of postoperative macular hole development. Retina. 2023;43:1872–80.PubMedPubMedCentral
44.
go back to reference Gohil R, Sivaprasad S, Han LT, Mathew R, Kiousis G, Yang Y. Myopic foveoschisis: a clinical review. Eye (Lond). 2015;29:593–601.PubMedCrossRef Gohil R, Sivaprasad S, Han LT, Mathew R, Kiousis G, Yang Y. Myopic foveoschisis: a clinical review. Eye (Lond). 2015;29:593–601.PubMedCrossRef
Metadata
Title
Surgical outcomes of non-fovea-sparing internal limiting membrane peeling using a double-staining technique for symptomatic myopic foveoschisis: a retrospective study
Authors
Tadashi Mizuguchi
Masayuki Horiguchi
Atsuhiro Tanikawa
Yasuki Ito
Publication date
03-02-2025
Publisher
Springer Japan
Published in
Japanese Journal of Ophthalmology
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-024-01158-z