Multimodal Analysis on Clinical Characteristics of the Advanced Stage in Myopic Traction Maculopathy.

INTRODUCTION: Here we investigate the clinical features of foveal detachment (FD), full-thickness macular hole (MH), and macular hole retinal detachment (MHRD) in myopic traction maculopathy (MTM). METHODS: In the retrospective observational case series, 314 eyes of 198 patients with myopic retinoschisis in Beijing Tongren Hospital were enrolled. We recorded gender, age, and axial length and evaluated fundus characteristics using optical coherence tomography. Epiretinal membranes (ERMs), vitreoretinal traction, and paravascular abnormalities (PVAs) were used to describe the vitreoretinal interface condition. Different retinoschisis layers (inner, middle, and outer retinoschisis) and the location with a range of outer retinoschisis were evaluated to reveal the retinal condition. Five patterns of the scleral shape: dome-shaped, sloped toward the optic nerve, symmetrical or asymmetrical around the fovea, and irregular were assessed to show retina-sclera condition. We regarded the FD, full-thickness MH, and MHRD as the advanced stage in MTM. Multivariate logistic regression assessed significant factors for the advanced stage with odds ratios (OR) and 95% confidence intervals (CI). RESULTS: There were 76 eyes with FD, 6 eyes with full-thickness MH, and 7 eyes with MHRD. The mean age was 52.9 ± 12.3 years. On univariate analysis, the eyes with the advanced stage were older and had higher rates of ERMs, PVAs, middle retinoschisis, outer retinoschisis, and irregular sclera shape. The number of retinoschisis layers and the grade of outer retinoschisis were higher in eyes with the advanced stage. After multivariate logistic regression, ERMs (OR 1.983; 95% CI 1.093-3.595; P = 0.024), middle retinoschisis (OR 2.967; 95% CI 1.630-5.401; P < 0.001), and higher grades of outer retinoschisis (OR 2.227; 95% CI 1.711-2.898; P < 0.001) remained associated with the advanced stage. CONCLUSION: ERMs, middle retinoschisis, and more extensive outer retinoschisis were significant characteristics of the advanced stage in MTM.

Long-term outcome of pathologic myopic foveoschisis treated with posterior scleral reinforcement followed by vitrectomy.

AIM: To report the long-term outcome of posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic myopic foveoschisis (MF). METHODS: The records of 27 patients (44 eyes) treated with posterior scleral reinforcement (PSR) followed by vitrectomy for pathologic MF were retrospectively reviewed. The best-corrected visual acuity (BCVA), refractive error, axial length, and spectral-domain optical coherence tomography findings and complications were analyzed. RESULTS: Forty-four eyes of 27 patients were included in this study. The follow-up period was 47.98±18.23mo (24-83mo). The mean preoperative BCVA (logMAR) was 1.13±0.63, and the mean postoperative BCVA was 0.30±0.33 at the last visit. There showed a significant improvement in BCVA postoperatively (P<0.001). Postoperative BCVA in 41 eyes (93%) was improved compared with the preoperative one. Forty-two eyes (95.45%) got total resolution of the MF after surgery. The remaining two eyes (4.55%) got partial resolution of foveoschisis. The preoperative foveal thickness was 610.45±217.11 µm and the postoperative foveal thickness at the last visit was significantly reduced to 177.64±55.40 µm (P<0.001). The preoperative axial length was 29.60±1.71 mm, and the postoperative axial length was 29.74±1.81 mm at the last visit. There was no significant increase in axial length within 47.98±18.23mo of follow-up (P=0.562). There was no recurrence of foveoschisis or occurrence of full-thickness macular hole during the whole follow-up period. CONCLUSION: For pathologic MF, PSR followed by vitrectomy is an effective procedure to improve the visual acuity and the anatomical structure of macula. It can also stabilize the axial length for a long time.

Investigation of Macular Choroidal Thickness and Blood Flow Change by Optical Coherence Tomography Angiography After Posterior Scleral Reinforcement.

Purpose: This work aimed to study the effect of posterior scleral reinforcement (PSR) on choroidal thickness (CT) and blood flow. Methods: This study included 25 eyes of 24 patients with high myopia ( ≤ -6.0 dioptres or axial length ≥ 26.0 mm) who underwent PSR surgery. All patients completed the 1-month follow-up visit. Myopic macular degeneration (MMD) was graded according to the International Meta-Analysis for Pathologic Myopia (META-PM) classification based on color fundus photographs. Swept-source optical coherence tomography angiography (SSOCTA) was performed to investigate CT, choroidal perfusion area (CPA), and choriocapillaris perfusion area (CCPA) change following PSR surgery. Results: The distribution of MMD categories was 9 (36.0%) in category 1, 10 (40.0%) in category 2, and 6 (24.0%) in category 3 or 4. MMD severity was strongly correlated with CT (all P < 0.01) and CPA (all P < 0.04). Postoperative CT at each sector increased significantly at 1 week's follow-up, compared to preoperative measures (all P < 0.05). Postoperative CPA at subfoveal, superior, inferior, and nasal sectors also increased significantly 1 week after PSR surgery (all P < 0.05). Moreover, the increased CT, CPA, and CCPA remain after PSR surgery at 1 month's follow-up, but the difference was not statistically significant. Conclusions: We demonstrated that the CT and choroidal blood flow increased significantly in patients with high myopia who underwent PSR surgery in a short period of time. In addition, the CT and CPA were independently associated with MMD. However, whether the transient improvement of the choroidal circulation could prevent long-term progression of high myopia warrants further study in the future.

Outcome of scleral buckling with or without gas tamponade for recurrent retinal detachment in post-vitrectomy eyes.

BACKGROUND: Treatment of recurrent retinal detachment (re-RD) following vitrectomy (post-gas/air tamponade and post-silicone oil removal) is challenging. Previously reported treatment is commonly revision pars plana vitrectomy (PPV) combined with tamponade, which is invasive and a burden both economically and emotionally when compared with scleral buckling (SB). The purpose of this study is to report anatomical and functional outcomes of SB with or without gas tamponade in eyes with recurrent retinal detachment (re-RD) that previously underwent PPV at least once. METHODS: We retrospectively reviewed the medical records of 14 patients (14 eyes) who underwent PPV at least once and were treated with SB after re-RD. Preoperative characteristics, intraoperative complications, and postoperative data were assessed. The final anatomical and functional outcomes were analyzed. RESULTS: The original PPV was performed for primary rhegmatogenous retinal detachment in 11 eyes, macular hole retinal detachment in 2 eyes, and myopic foveoschisis in 1 eye. Previously, 3 eyes underwent one PPV with gas tamponade, and the remaining 11 (79%) eyes underwent 2-5 operations. Seven eyes underwent the procedure with gas injection. At the last follow-up, 13 eyes achieved total retinal attachment and 1 eye had re-RD. The postoperative intraocular pressure was within the normal range, except in 1 eye (6 mmHg). The finest postoperative best-corrected visual acuity (BCVA) was 20/25. There was a significant improvement in BCVA from 20/160 ± 20/63 at baseline to 20/80 ± 20/50 at the last visit in the 13 successfully treated eyes (P = 0.025). CONCLUSIONS: SB can be effective for re-RD after PPV in specific cases.

Posterior Scleral Reinforcement to Prevent Progression of High Myopia.

BACKGROUND: Myopia has become a global public health problem. High myopia is linked to pathologic myopia (PM). As the severity of myopia increases, excessive axial elongation of the globe exerts a biomechanical stretch on the posterior pole, followed by a series of retinopathy which can lead to marked visual impairment. Posterior scleral reinforcement (PSR) is the only way that may have the potential to prevent the progression of axial elongation. Some scholars expressed satisfaction with the efficacy and safety of PSR. In contrast, other surgeons had negative conclusions on the outcomes for the surgery. OBJECTIVES: The aims of this review are to provide an update on the current knowledge of posterior scleral reinforcement to prevent progression of high myopia and to discuss clinical trials examining the potential utility of PSR in treating this disease. METHODS: We searched Ovid MEDLINE, Embase, PubMed and China National Knowledge Infrastructure (CNKI) (all years to 1 July 2019). We also conducted a gray literature search and handsearched reference lists of included studies and pertinent review articles. RESULTS: 26 clinical trials were included. 20 trials were designed as only one eye of each patient had posterior scleral reinforcement surgery. After 3 to 5 years of follow-up, the results are very satisfactory. 6 randomized controlled trials, which have conservatively treated groups, showed statistically significant differences between the eyeball axial length progression in the study group and the control group, where surgery was not performed. Most clinical trials reached a positive influence. But the efficacy of different clinical trials varies greatly. CONCLUSIONS: PSR, is safe and effective to slowdown myopia progression, especially for high myopia.

Vascular flow density in pathological myopia: an optical coherence tomography angiography study.

OBJECTIVES: To investigate vascular flow density in pathological myopia with optical coherence tomography (OCT) angiography. DESIGN: A prospective comparative study was conducted from December 2015 to March 2016. SETTING: Participants were recruited in Beijing Tongren Hospital. PARTICIPANTS: A total of 131 eyes were enrolled, which were divided into three groups: 45 eyes with emmetropia (EM; mean spherical equivalent (MSE) 0.50D to -0.50D), 41 eyes with high myopia (HM; MSE ≤-6.00D, without pathological changes), and 45 eyes with pathological myopia (PM; MSE ≤-6.00D and axial length (AL) ≥26.5 mm, and with pathological changes). MAIN OUTCOME MEASURES: Macular, choriocapillaris and radial peripapillary capillary (RPC) flow densities were measured and compared between groups, and their relationships with AL and best corrected visual acuity (BCVA) were analysed. RESULTS: Significant differences were found in macular, choriocapillaris and RPC flow densities among the three groups (p<0.05). Multiple comparisons revealed that, compared with the EM and HM groups, macular and RPC flow densities of the PM group were significantly decreased (p<0.05), but no significant difference in choriocapillaris flow density was found between the PM and HM groups (p=0.731). Compared with the EM group, retinal flow density in the macular and arcuate fibre region was not decreased in the HM group. In addition, there was a negative correlation between AL and superficial macular flow density (ß=-0.542, p<0.001), deep macular flow density (ß=-0.282, p=0.002) and RPC flow density (ß=-0.522, p<0.001); and a positive correlation between BCVA and superficial macular flow density (ß=0.194, p=0.021), deep macular flow density (ß=0.373, p<0.001), and choriocapillaris flow density (ß=0.291, p=0.001). CONCLUSIONS: Macular and RPC flow densities decreased in pathological myopia compared with high myopia and emmetropia. No significant decrease of retinal flow density in the macular and arcuate fibre region was found in high myopic eyes compared with emmetropic eyes. Moreover, macular and RPC flow densities were negatively related to AL, and macular flow density was positively related to BCVA.

RISK FACTORS FOR DEVELOPMENT OF MACULAR HOLE RETINAL DETACHMENT AFTER PARS PLANA VITRECTOMY FOR PATHOLOGIC MYOPIC FOVEOSCHISIS.

PURPOSE: To identify the risk factors for the development of macular hole retinal detachment (MHRD) after vitrectomy without internal limiting membrane peeling for pathologic MF. METHODS: 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. RESULTS: 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). CONCLUSION: Preoperative foveal detachment is a risk factor for the development of MHRD after vitrectomy for pathologic MF.

Application of optical coherence tomography angiography in assessment of posterior scleral reinforcement for pathologic myopia.

AIM: To investigate the effect of posterior scleral reinforcement (PSR) on circulation of pathologic myopia eyes with posterior staphyloma by optical coherence tomography angiography (OCTA). METHODS: The study included 30 pathologic myopia eyes with posterior staphyloma which underwent PSR (PSR group) for 6 to 18mo ago, and 30 age and myopia matched eyes without PSR surgery as control group. Macular, choriocapillaris and radial peripapillary capillary (RPC) flow density were measured by OCTA, and the measurements were compared between groups. RESULTS: OCTA found no significant differences in macular flow density between PSR and control groups. For the superficial flow, whole enface flow density (WED), fovea density (FD), and parafoveal density (PD) were 46.55%±5.19% vs 47.29%±4.12% (P=0.542), 31.45%±6.35% vs 31.17%±4.48% (P=0.841), and 48.82%±5.66% vs 49.21%±4.15% (P=0.756) in PSR and control groups, respectively. For the deep flow, WED, FD, and PD were 52.07%±5.78% vs 53.95%±4.62% (P=0.168), 29.62%±6.55% vs 29.50%±6.38% (P=0.940), and 56.93%±6.17% vs 58.15%±5.13% (P=0.407) in PSR and control groups, respectively. The choriocapillary flow density was 61.18±3.25% in PSR group vs 60.88%±2.56% in control group (P=0.692). Also, OCTA found no significant differences in RPCs flow density between PSR and control groups. The optic disc WED, inside disc flow density and peripapillary flow density were 48.47%±4.77% vs 48.11%±4.57% (P=0.813), 45.47%±11.44% vs 46.68%±9.02% (P=0.709), 54.32%±5.29% vs 52.47%±6.62% (P=0.349) in PSR and control groups, respectively. CONCLUSION: OCTA provides a non-invasive and quantitative approach for monitoring macular and papillary blood flow in pathologic myopia. PSR can not improve but may maintain the circulation of pathologic myopia eyes with posterior staphyloma.

Complications after heavy silicone oil tamponade in complicated retinal detachment.

PURPOSE: To observe the complications after heavy silicone oil (HSO) tamponade in complicated retinal detachment. METHODS: Thirty-three eyes of 33 patients with complicated retinal detachment were included in this retrospective study. Vitrectomy and HSO tamponade were performed in all patients. Other surgical procedures were performed as necessary. The main outcome measures included retinal reattachment, visual acuity, intraocular pressure, intraocular inflammation, lens opacity, and HSO emulsification. RESULTS: The patients were followed up for 3 months to 24 months (average, 8.1 ± 5.3 months). Retinal reattachment was achieved in 29 eyes (87.9%) with a first surgery and in 33 eyes (100%) with a second surgery. In all 33 eyes, HSO had been removed and the visual acuity was improved. Short-term (within 2 weeks after operations) complications included temporarily increased intraocular pressure and mild inflammation in the anterior chamber. Major long-term complications included cataract (100%) and HSO emulsification (42.4%). Other long-term complications included ocular hypertension (12.1%), retinal detachment and proliferative vitreoretinopathy (12.1%), and low intraocular pressure (9.1%). CONCLUSION: Heavy silicone oil tamponade is safe and effective to treat complicated retinal detachment. The most common complications are cataract and HSO emulsification.

[The pilot study of intravitreal injection of triamcinolone acetonide for treatment of retinal detachment with choroidal detachment].

OBJECTIVE: To evaluate the efficiency and safety of intravitreal injection of triamcinolone acetonide for treatment of retinal detachment with choroidal detachment. METHODS: 13 the patients (13 eyes) of retinal detachment with choroidal detachment were chosen and triamcinolone acetonide 0.1 ml (4 mg) were administrated via intravitreal injection through pars plana. The therapeutic effects on uveitis and choroidal detachment was analyzed. The retinal reattachment surgery was performed five to ten days after the injection. RESULTS: all 13 patients receiving triamcinolone acetonide demonstrated alleviated uveitis to some degree. The rate of retinal holes detection increased from 2/13 pre-injection to 7/13 post-operation. Choroidal detachment disappeared in most of cases within 10 days triamcinolone acetonide injection. Five eyes underwent scleral buckling, 6 eyes underwent with vitrectomy, and 2 patients abandoned surgery. The average follow up after surgery was 4 and half months. All eyes received with triamcinolone acetonide injection and surgery had retinal reattached successfully and no side effects were detected. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide was an effective and safe method to treat choroidal detachment and alleviate uveitis. The injection simplified surgery procedure and improve the success rate of retinal detachment.