Posterior scleral reinforcement using genipin-cross-linked sclera for macular hole retinal detachment in highly myopic eyes.

BACKGROUND/AIMS: To investigate the surgical outcomes of posterior scleral reinforcement (PSR) using genipin-cross-linked sclera to treat macular hole retinal detachment (MHRD) in highly myopic eyes. METHODS: Nineteen patients with high myopia (19 eyes) with MHRD were treated sequentially with genipin-cross-linked PSR and were followed at least for 1 year after the surgery. The best corrected visual acuity (BCVA), axial length (AL), optical coherence tomography (OCT) outcomes and the complications were evaluated. RESULTS: Macular hole was closed in 73.7% of the eyes, foveal reattachment rate was 100%. The mean logMAR BCVA improved from 1.27±0.55 preoperatively to 0.88±0.55 postoperatively. The preoperative AL (29.88±1.97 mm) was decreased (27.73±1.84 mm) after the operation (p<0.001). CONCLUSIONS: For at least a 1-year period of follow-up, PSR with genipin-cross-linked sclera should be considered as a preferred surgical approach to treat MHRD in highly myopic eyes, especially when foveal retinoschisis is also documented.

The efficacy and safety of posterior scleral reinforcement using genipin cross-linked sclera for macular detachment and retinoschisis in highly myopic eyes.

BACKGROUND/AIMS: To evaluate the efficacy and safety of posterior scleral reinforcement (PSR) using genipin cross-linked sclera as the material to treat macular detachment and retinoschisis, both without macular hole, in highly myopic eyes. METHODS: Twenty-one patients with highly myopic eyes (24 eyes) with macular detachment and retinoschisis were treated sequentially with genipin cross-linked PSR and were followed for at least 1 year after surgery. The best-corrected visual acuity (BCVA), spherical equivalent (SE) power, axial length (AL), optical coherence tomography, and the complications were evaluated. RESULTS: The mean SE decreased from -13.81±4.67 D preoperatively to -9.64±4.86 D postoperatively, while the improvement in the logMAR BCVA values was from 1.24±0.57 before surgery to 1.03±0.57 after surgery. The preoperative AL (29.73±2.31 mm) was decreased (28.08±2.08 mm) after the operation. The retina in 21 eyes (87.5%) was successful reattached and the macular detachment was significantly decreased in two eyes; a macular hole occurred in one eye. CONCLUSIONS: For at least a 1 year period of follow-up, PSR with genipin cross-linked sclera was safe and effective to treat macular detachment and retinoschisis in high myopia when a macular hole was not present. The reinforcement effect tended to be stabilised and maintained for 6 months after treatment.

[Vitrectomy without internal limiting membrane peeling associated with gas tamponade for treatment of foveoschisis in pathologic myopia].

OBJECTIVE: To evaluate the efficacy of vitrectomy without internal limiting membrane (ILM) peeling associated with gas tamponade in eyes with myopic foveoschisis. METHODS: A prospective study was conducted, in which 49 pathological myopia patients (52 eyes) with myopic foveoschisis were enrolled and divided into three groups according to the different therapeutic procedures: 22 patients (24 eyes) underwent vitrectomy without internal limiting membrane (non-gas tamponade group), 15 patients (16 eyes) received vitrectomy without internal limiting membrane peeling but combined with gas tamponade (gas tamponade group) and 12 patients (12 eyes) did not receive surgical treatments (control group). SAS 9.13 was used for the statistic analysis. Best-corrected visual acuity (BCVA) and optical coherence tomographic (OCT) findings of the foveal thickness before and after the operation (the 3rd, 6th, and 9th month postoperatively) were obtained and compared by the Wilcoxon Rank-Sum test. Non-parameters Wilcoxon symbols test was used to compare the BCVA, the central foveal thickness (CFT) and maximum foveal thickness (MxFT) of each group before and after the surgery. RESULTS: Postoperative visual acuity was significantly increased in the two operation groups (t = 2.57, P < 0.05; t = 3.58, P < 0.05) but not increased in the control group (t = 1.84; P > 0.05). The difference of BCVA between these three groups was not significant (χ(2) = 0.24, P > 0.05). OCT showed the mean foveal thickness was significantly decreased postoperatively. Vitrectomy without peeling of the ILM significantly promoted the retinal reattachment in eyes with myopic foveoschisis. No retinal reattachment was found in the control group while 16 and 13 retinal reattachment were found in the non-gas tamponade (66.7%) and gas tamponade group (81.3%), the difference between these two operation groups and the control was statistically significant (χ(2) = 20.50, P < 0.05). During the follow-up, two eyes in the control group developed a macular hole and both developed retinal detachment (RD) in the 6 and 8 month, respectively. The remaining 10 eyes did not develop any complications, although the thickness of the macula increased significantly. A transient increase of intraocular pressure occurred in three eyes and had been cured by medications within 2 weeks after gas tamponade. A macular hole was recognized in one eye 2 months after surgery and the retina was reattached at the fovea 1 month after reoperation. CONCLUSIONS: Vitrectomy without ILM peeling could be a safe and effective surgical approach for the treatment of foveoschisis in pathologic myopia. In addition, gas tamponade can improve the success rate of the operation.

[Change of accommodative function in phakic eyes with iris-fixated phakic intraocular lens implantation].

OBJECTIVE: To evaluate the changes of accommodative function after implantation of iris-fixated phakic intraocular lens (IFPIOL) for correction of high myopia, and compared with gender and age matched emmetropes. This study also provides clinical basis for assessing the quality of life after implantation of the IFPIOL. METHODS: It was a case-control study. Iris-fixated in phakic intraocular lens implantation was performed in 23 eyes of 12 high myopic patients. Control group included 22 eyes in 11 emmetropes. All patients and controlled subjects had the same examinations including amplitude of accommodation, accommodative facility test, and negative/positive relative accommodation before, 1 month and 3 months after operation. Surgery was performed by the same surgeon. Randomized block design analysis of variance was applied to analyze accommodative function between the patients preoperative and postoperative, and two independent samples t-test was applied to analyze accommodative function between the control group and the patients. P value less than 0.05 was considered significant. RESULTS: The mean amplitude of accommodation at 1 month and 3 months was (8.90 ± 2.13) D and (9.10 ± 1.72) D after IFPIOL implantation, respectively. Mean amplitude of accommodation after the operation was significantly greater than that from preoperative eyes (7.35 ± 2.20) D, (F = 19.88, P < 0.01). Mean amplitude of accommodation at 3 months in eyes after IFPIOL implantation showed no significant difference (t = -1.76, P = 0.09) as compared with the control group (10.10 ± 2.09) D. Mean accommodative facility at 1 month and 3 months after IFPIOL implantation was (8.17 ± 2.09) cyc/min and (8.67 ± 1.80) cyc/min, respectively. This was significantly increased from preoperative data which was (5.67 ± 1.53) cyc/min, (F = 64.27, P < 0.01). Mean accommodative facility at 3 months after IFPIOL implantation had no statistically significant difference (t = -6.29, P < 0.01) as compared with the control group (14.51 ± 3.81) cyc/min. In addition, mean positive relative accommodation (2.45 ± 0.81) D was significantly greater than that in preoperative eyes (1.61 ± 0.80) D, (F = 6.10, P = 0.01) but, not significantly different (t = -2.83, P = 0.01) from the control group (3.89 ± 1.49) D. CONCLUSIONS: Patients can obtain physiological accommodative function after the implantation of IFPIOL for correction of high myopia. Moreover, the accommodative function increases with time and is stable. Nevertheless, accommodative function could not reach the level of normal emmetropic eyes. Longer-term results would be further observed.

Proposed classification of lens capsule defects.

BACKGROUND: Capsule defects are common during or after intraocular surgery of various kinds. The purpose of this work is to establish a classification system of lens capsule defects to provide uniform description of these defects for ophthalmic research and IOL implantation. METHODS: A retrospective study of 128 patients (156 eyes) with lens capsule injury after ocular trauma and intraocular surgery was performed. The patients were divided into two groups. Capsule defects were defined and classified according to the location, size, shape and tension of the capsule and its effect on posterior chamber IOL implantation. RESULTS: Lens capsule defects were classified into four types: Type I - complete capsule; Type II - incomplete capsule, but has enough area and tension to support two IOL haptics; Type III - incomplete capsule, is able to support only one IOL haptic and the other haptic needs a suture; Type IV - no capsule, both IOL haptics need suture fixation. Type I and Type II were each divided into three subtypes. Type III was divided into two subtypes. The shape of the capsule defects included fissure-like, triangle, round, irregular and fan-like. All eyes with capsule defects can be sorted into one of these types, and it is easy to guide IOL implantation according to the classification. Type II was the most common among the two groups in this study. CONCLUSION: The classification of lens capsule defects is feasible and favorable for uniform clinical description, clinical research and IOL implantation.