The effect of vitrectomy combined total versus fovea-sparing peeling of internal limiting membrane for myopic foveoschisis_Chinese Journal of Ocular Fundus Diseases

Authors：

He Hailong ¹ , Fang Yuxin ² , Liu Zhenyu ¹ , Zhou Chunyuan ³ , She Haicheng ² , Wan Xiuhua ¹ ,  Jin Zibing ¹

1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China;
2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China;
3. Liangxiang Hospital of Beijing Fangshan District, Beijing 102401, China;

Corresponding?author：

Jin Zibing, Email: jinzb502@ccmu.edu.cn

Keywords：

Myopia, degenerative; Macular schisis; Vitrectomy; Internal limiting membrane peeling; Meta analysis

DOI：

10.3760/cma.j.cn511434-20210910-00505

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Objective To systematically evaluate the effect of pars plana vitrectomy (PPV) combined total peeling of internal limiting membrane (ILM) versus fovea-sparing peeling of ILM for myopic foveoschisis. Methods A evidence-based medicine study. Chinese and English as search terms for myopic foveoschisis, vitrectomy, and peeling of internal limiting membrane were used to search literature in China National Knowledge Infrastructure, Wanfang database, VIP database, PubMed of National Library of Medicine, Medline, Embase, and Cochrane Library. The high myopic macular schisis was selected as the research object, the intervention method was PPV combined with complete ILM peeling and combined with foveal preservation ILM peeling surgery clinical control study between Jan 1, 2010, and Jun 31, 2021. Incomplete or irrelevant literature and review literature were excluded. The method of Newcastle-Ottawa Scale system was used to evaluate the included literature. The literature was meta-analyzed by RevMan5.3 software. The mean difference (MD) and a confidence interval (CI) of 95% were used to describe the effect sizes of continuous data, fixed effects model was performed. The data including the best corrected visual acuity (BCVA), central fovea thickness (CFT), and postoperative macular hole (MH) were analyzed. Results In those databases, 232 articles based search stratery were totally retrieved, and 10 articles (417 eyes) were finally included for meta-analysis with 245 eyes for PPV combined total peeling of ILM and 172 eyes for PPV combined fovea-sparing peeling of ILM. Meta-analysis results showed there was no significant difference in BCVA and CFT between the two groups (BCVA: MD=0.05, 95%CI 0.00-0.11; P＞0.05; CFT: MD=－4.79, 95%CI －18.69-9.11, P＞0.05). It was compared with the incidence of MH, the difference was statistically significant (odds ratio=5.70, 95%CI 2.22-14.61, P＜0.05). Conclusion BCVA and CFT could be improved by PPV combined total and fovea-sparing peeling of ILM for myopic foveoschisis; compared with complete ILM peeling, the incidence of MH was lower after foveal-sparing ILM peeling.

Citation： He Hailong, Fang Yuxin, Liu Zhenyu, Zhou Chunyuan, She Haicheng, Wan Xiuhua, Jin Zibing. The effect of vitrectomy combined total versus fovea-sparing peeling of internal limiting membrane for myopic foveoschisis. Chinese Journal of Ocular Fundus Diseases, 2022, 38(10): 823-828. doi: 10.3760/cma.j.cn511434-20210910-00505 Copy

1.	Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476. DOI: 10.1016/s0002-9394(02)01937-2.
2.	Ho TC, Yang CM, Huang JS, et al. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy[J]. Retina, 2014, 34(9): 1833-1840. DOI: 10.1097/IAE.0000000000000149.
3.	Elwan MM, Abd Elghafar AE, Hagras SM, et al. Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis[J]. Eur J Ophthalmol, 2019, 29(1): 69-74. DOI: 10.1177/1120672117750059.
4.	朱麗, 陳曉, 晏穎, 等. 玻璃體切割聯合內界膜完全剝除和保留中心凹內界膜剝除手術治療高度近視黃斑劈裂的療效比較[J]. 中華眼底病雜志, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.Zhu L, Chen X, Yan Y, et al. Comparison of the efficacy of vitrectomy combined with complete internal limiting membrane peeling and fovea-sparing internal limiting membrane peeling for high myopia macular foveoschisis[J]. Chin J Ocul Fundus Dis, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.
5.	應佳, 李俊, 徐格致, 等. 玻璃體切除聯合內界膜剝除術治療高度近視眼黃斑劈裂的療效觀察[J]. 中華眼科雜志, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.Ying J, Li J, Xu GZ, et al. Therapeutic effects of pars plana vitrectomy combined with internal limiting membrane peeling on high myopic foveoschisis[J]. Chin J Ophthalmol, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.
6.	Shiraki N, Wakabayashi T, Ikuno Y, et al. Fovea-sparing versus standard internal limiting membrane peeling for myopic traction maculopathy: a study of 102 consecutive cases[J]. Ophthalmol Retina, 2020, 4(12): 1170-1180. DOI: 10.1016/j.oret.2020.05.016.
7.	Itoh Y, Inoue M, Kato Y, et al. Alterations of foveal architecture during vitrectomy for myopic retinoschisis identified by intraoperative optical coherence tomography[J]. Ophthalmologica, 2019, 242(2): 87-97. DOI: 10.1159/000500362.
8.	Iwasaki M, Miyamoto H, Okushiba U, et al. Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy[J]. Jpn J Ophthalmol, 2020, 64(1): 13-21. DOI: 10.1007/s10384-019-00696-1.
9.	王艷輝, 張勝娟, 李云環, 等. 25G微創玻璃體切除聯合完全內界膜剝除與聯合保留中心凹處內界膜剝除術治療高度近視黃斑劈裂的效果比較[J]. 臨床眼科雜志, 2018, 26(5): 385-389. DOI: 10.3969/j.issn.1006-8422.2018.05.001.Wang YH, Zhang SJ, Li YH, et al. Comparison of the effect of 25G vitrectomy with internal limiting membrane peeling and with fovea-sparing internal limiting membrane peeling for myopic foveoschisis[J]. J Clin Ophthalmol, 2018, 26(5): 385-389. DOI: 10.3969/j.issn.1006-8422.2018.05.001.
10.	Tian T, Jin H, Zhang Q, et al. Long-term surgical outcomes of multiple parfoveolar curvilinear internal limiting membrane peeling for myopic foveoschisis[J]. Eye (Lond), 2018, 32(11): 1783-1789. DOI: 10.1038/s41433-018-0178-0.
11.	Shimada N, Sugamoto Y, Ogawa M, et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy[J]. Am J Ophthalmol, 2012, 154(4): 693-701. DOI: 10.1016/j.ajo.2012.04.013.
12.	Gohil R, Sivaprasad S, Han LT, et al. Myopic foveoschisis: a clinical review[J]. Eye (Lond), 2015, 29(5): 593-601. DOI: 10.1038/eye.2014.311.
13.	Azuma K, Hirasawa K, Araki F, et al. Fovea-sparing as opposed to total peeling of internal limiting membrane for myopic foveoschisis: a systematic review and meta-analysis[J]. Ophthalmol Retina, 2021, 5(7): 670-679. DOI: 10.1016/j.oret.2020.10.010.
14.	Kumagai K, Furukawa M, Ogino N, et al. Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Retina, 2010, 30(6): 874-880. DOI: 10.1097/IAE.0b013e3181c703fc.
15.	Gui J, Ai L, Huang T. Vitrectomy with or without internal limiting membrane peeling for myopic foveoschisis[J]. BMC Ophthalmol, 2020, 20(1): 83. DOI: 10.1186/s12886-020-01354-8.
16.	Jin H, Zhang Q, Zhao P. Fovea sparing internal limiting membrane peeling using multiple parafoveal curvilinear peels for myopic foveoschisis: technique and outcome[J]. BMC Ophthalmol, 2016, 16(1): 180. DOI: 10.1186/s12886-016-0356-4.
17.	Kim KS, Lee SB, Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis[J]. Am J Ophthalmol, 2012, 153(2): 320-326. DOI: 10.1016/j.ajo.2011.07.007.
18.	Gao X, Ikuno Y, Fujimoto S, et al. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol, 2013, 155(6): 1021-1027. DOI: 10.1016/j.ajo.2013.01.023.
19.	Sisk RA, Toygar O. Full-thickness macular hole formation after internal limiting membrane peeling: beware the "Omega Sign"[J/OL]. Case Rep Ophthalmol Med, 2016, 2016: 9858291[2016-09-25]. https://pubmed.ncbi.nlm.nih.gov/27747120/. DOI: 10.1155/2016/9858291.
20.	Lee CL, Wu WC, Chen KJ, et al. Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery[J]. Acta Ophthalmol, 2017, 95(2): 128-131. DOI: 10.1111/aos.13115.
21.	Wang L, Wang Y, Li Y, 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[J/OL]. Medicine (Baltimore), 2019, 98(9): e14710[2019-03-01]. https://pubmed.ncbi.nlm.nih.gov/30817612/. DOI: 10.1097/MD.0000000000014710.
22.	Yun LN, Xing YQ. Long-term outcome of highly myopic foveoschisis treated by vitrectomy with or without gas tamponade[J]. Int J Ophthalmol, 2017, 10(9): 1392-1395. DOI: 10.18240/ijo.2017.09.10.
23.	Panozzo G, Mercanti A. Vitrectomy for myopic traction maculopathy[J]. Arch Ophthalmol, 2007, 125(6): 767-772. DOI: 10.1001/archopht.125.6.767.

1. Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma[J]. Am J Ophthalmol, 1999, 128(4): 472-476. DOI: 10.1016/s0002-9394(02)01937-2.
2. Ho TC, Yang CM, Huang JS, et al. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy[J]. Retina, 2014, 34(9): 1833-1840. DOI: 10.1097/IAE.0000000000000149.
3. Elwan MM, Abd Elghafar AE, Hagras SM, et al. Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis[J]. Eur J Ophthalmol, 2019, 29(1): 69-74. DOI: 10.1177/1120672117750059.
4. 朱麗, 陳曉, 晏穎, 等. 玻璃體切割聯合內界膜完全剝除和保留中心凹內界膜剝除手術治療高度近視黃斑劈裂的療效比較[J]. 中華眼底病雜志, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.Zhu L, Chen X, Yan Y, et al. Comparison of the efficacy of vitrectomy combined with complete internal limiting membrane peeling and fovea-sparing internal limiting membrane peeling for high myopia macular foveoschisis[J]. Chin J Ocul Fundus Dis, 2020, 36(7): 509-513. DOI: 10.3760/cma.j.cn511434-20200102-00001.
5. 應佳, 李俊, 徐格致, 等. 玻璃體切除聯合內界膜剝除術治療高度近視眼黃斑劈裂的療效觀察[J]. 中華眼科雜志, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.Ying J, Li J, Xu GZ, et al. Therapeutic effects of pars plana vitrectomy combined with internal limiting membrane peeling on high myopic foveoschisis[J]. Chin J Ophthalmol, 2020, 56(12): 928-932. DOI: 10.3760/cma.j.cn112142-20200319-00204.
6. Shiraki N, Wakabayashi T, Ikuno Y, et al. Fovea-sparing versus standard internal limiting membrane peeling for myopic traction maculopathy: a study of 102 consecutive cases[J]. Ophthalmol Retina, 2020, 4(12): 1170-1180. DOI: 10.1016/j.oret.2020.05.016.
7. Itoh Y, Inoue M, Kato Y, et al. Alterations of foveal architecture during vitrectomy for myopic retinoschisis identified by intraoperative optical coherence tomography[J]. Ophthalmologica, 2019, 242(2): 87-97. DOI: 10.1159/000500362.
8. Iwasaki M, Miyamoto H, Okushiba U, et al. Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy[J]. Jpn J Ophthalmol, 2020, 64(1): 13-21. DOI: 10.1007/s10384-019-00696-1.
9. 王艷輝, 張勝娟, 李云環, 等. 25G微創玻璃體切除聯合完全內界膜剝除與聯合保留中心凹處內界膜剝除術治療高度近視黃斑劈裂的效果比較[J]. 臨床眼科雜志, 2018, 26(5): 385-389. DOI: 10.3969/j.issn.1006-8422.2018.05.001.Wang YH, Zhang SJ, Li YH, et al. Comparison of the effect of 25G vitrectomy with internal limiting membrane peeling and with fovea-sparing internal limiting membrane peeling for myopic foveoschisis[J]. J Clin Ophthalmol, 2018, 26(5): 385-389. DOI: 10.3969/j.issn.1006-8422.2018.05.001.
10. Tian T, Jin H, Zhang Q, et al. Long-term surgical outcomes of multiple parfoveolar curvilinear internal limiting membrane peeling for myopic foveoschisis[J]. Eye (Lond), 2018, 32(11): 1783-1789. DOI: 10.1038/s41433-018-0178-0.
11. Shimada N, Sugamoto Y, Ogawa M, et al. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy[J]. Am J Ophthalmol, 2012, 154(4): 693-701. DOI: 10.1016/j.ajo.2012.04.013.
12. Gohil R, Sivaprasad S, Han LT, et al. Myopic foveoschisis: a clinical review[J]. Eye (Lond), 2015, 29(5): 593-601. DOI: 10.1038/eye.2014.311.
13. Azuma K, Hirasawa K, Araki F, et al. Fovea-sparing as opposed to total peeling of internal limiting membrane for myopic foveoschisis: a systematic review and meta-analysis[J]. Ophthalmol Retina, 2021, 5(7): 670-679. DOI: 10.1016/j.oret.2020.10.010.
14. Kumagai K, Furukawa M, Ogino N, et al. Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis[J]. Retina, 2010, 30(6): 874-880. DOI: 10.1097/IAE.0b013e3181c703fc.
15. Gui J, Ai L, Huang T. Vitrectomy with or without internal limiting membrane peeling for myopic foveoschisis[J]. BMC Ophthalmol, 2020, 20(1): 83. DOI: 10.1186/s12886-020-01354-8.
16. Jin H, Zhang Q, Zhao P. Fovea sparing internal limiting membrane peeling using multiple parafoveal curvilinear peels for myopic foveoschisis: technique and outcome[J]. BMC Ophthalmol, 2016, 16(1): 180. DOI: 10.1186/s12886-016-0356-4.
17. Kim KS, Lee SB, Lee WK. Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis[J]. Am J Ophthalmol, 2012, 153(2): 320-326. DOI: 10.1016/j.ajo.2011.07.007.
18. Gao X, Ikuno Y, Fujimoto S, et al. Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis[J]. Am J Ophthalmol, 2013, 155(6): 1021-1027. DOI: 10.1016/j.ajo.2013.01.023.
19. Sisk RA, Toygar O. Full-thickness macular hole formation after internal limiting membrane peeling: beware the "Omega Sign"[J/OL]. Case Rep Ophthalmol Med, 2016, 2016: 9858291[2016-09-25]. https://pubmed.ncbi.nlm.nih.gov/27747120/. DOI: 10.1155/2016/9858291.
20. Lee CL, Wu WC, Chen KJ, et al. Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery[J]. Acta Ophthalmol, 2017, 95(2): 128-131. DOI: 10.1111/aos.13115.
21. Wang L, Wang Y, Li Y, 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[J/OL]. Medicine (Baltimore), 2019, 98(9): e14710[2019-03-01]. https://pubmed.ncbi.nlm.nih.gov/30817612/. DOI: 10.1097/MD.0000000000014710.
22. Yun LN, Xing YQ. Long-term outcome of highly myopic foveoschisis treated by vitrectomy with or without gas tamponade[J]. Int J Ophthalmol, 2017, 10(9): 1392-1395. DOI: 10.18240/ijo.2017.09.10.
23. Panozzo G, Mercanti A. Vitrectomy for myopic traction maculopathy[J]. Arch Ophthalmol, 2007, 125(6): 767-772. DOI: 10.1001/archopht.125.6.767.

Chinese Journal of Ocular Fundus Diseases

The effect of vitrectomy combined total versus fovea-sparing peeling of internal limiting membrane for myopic foveoschisis

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