This paper aims to investigate the surgical efficacy of vitrectomy on myopic foveoschisis (MF) and its related factors. We reviewed the clinical data of MF patients who received vitrectomy surgery in the Department of Ophthalmology of the First Affiliated Hospital of Zhengzhou University between January 2020 and August 2022, and analyzed the efficacy of vitrectomy surgery in treating MF. Furthermore,we investigated the correlation between preoperative clinical characteristics of the eyes affected by MF and surgical efficacy. Our results are as follows: A total of 56 MF patients (61 eyes) were included in this study, with a mean age of 56.39±10.39 (33-75) years. After surgery, 50 eyes (82.0%) showed improved visual acuity compared with the preoperative period, 12 eyes (19.7%) got MF reattached, and 33 eyes (54.1%) got MF partially reattached, and MF did not further develop in all eyes during postoperative follow-up. Compared with MF eyes with improved postoperative visual acuity, MF eyes with unimproved postoperative visual acuity had longer axial length (P=0.036), with a higher incidence of severe MF (P=0.004), but the incidences of vitreous adhesion and epi-retinal membrane(ERM), and central foveal thickness(CFT) were not significantly different between the two groups of MF eyes (P>0.05). Compared with MF eyes got reattached or partially reattached, the axial length of MF eyes that were not reattached were longer (P<0.001), with a similarly higher proportion of severe MF eyes (P=0.003), but there were no significant differences in the incidence of vitreous adhesion and ERM ,and the CFT between the two groups of MF eyes (P>0.05). Univariate and multivariate regression analyses showed that preoperative grading of the condition as severe was an independent risk factor for difficulty in improving visual acuity in postoperative MF eyes (P=0.030), and a long axial length was an independent risk factor for difficulty in resetting the MF in postoperative MF eyes (P=0.004).  In conclusion, our study can significantly improve that vitrectomy surgical treatment is safe and effective for most MF patients, and preoperative grading of severe MF and long ocular axis are risk factors for relatively poor surgical outcomes in eyes with MF.

Guo Yaqian, Pei Minghang, Wan Guangming. Analysis of Efficacy of Vitrectomy on Myopic Foveoschisis and Its Associated Factors. International Journal of Frontiers in Medicine (2024), Vol. 6, Issue 12: 1-8. https://doi.org/10.25236/IJFM.2024.061201.

[1] Fang D, Liang J, Chen S, et al. Surgical Outcomes of Myopic Foveoschisis According to the ATN Classification System[J]. Ophthalmol Ther,2022.

[2] Ruiz-Medrano J, Montero J A, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J ]. Prog Retin Eye Res,2019,69:80-115. 

[3] Sun C B, Liu Z, Xue A Q, et al. Natural evolution from macular retinoschisis to full-thickness macular hole in highly myopic eyes[J]. Eye (Lond),2010,24(12):1787-1791.

[4] Shimada N, Tanaka Y, Tokoro T, et al. Natural course of myopic traction maculopathy and factors associated with progression or resolution[J]. Am J Ophthalmol,2013,156(5):948-957. 

[5] Pei M, Zhao C, Gao F, et al. Analysis of Parafoveal Microvascular Abnormalities in Behcet's Uveitis Using Projection-Resolved Optical Coherence Tomographic Angiography[J]. Ocul Immunol Inflamm, 2021, 29(3):524-529. 

[6] Holladay J T. Proper method for calculating average visual acuity[J]. J Refract Surg, 1997, 13(4): 388-391. 

[7] Flores-Moreno I, Lugo F, Duker J S, et al. The relationship between axial length and choroidal thickness in eyes with high myopia[J]. Am J Ophthalmol,2013,155(2):314-319. 

[8] Gohil R, Sivaprasad S, Han L T, et al. Myopic foveoschisis: a clinical review[J]. Eye (Lond), 2015, 29(5):593-601. 

[9] Ruiz-Medrano J, Flores-Moreno I, Ohno-Matsui K, et al. Validation Of The Recently Developed Atn Classification And Grading System For Myopic Maculopathy [J]. Retina,2020,40(11):2113-2118.

[10] Chylack L J, Wolfe J K, Singer D M, et al. The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group[J]. Arch Ophthalmol,1993,111(6):831-836. 

[11] Wu DX, Pei MH, Wan GM..Correlation analysis on the OCT based parameters and visual prognosis of diabetic macular edema[J]. Chin J Ocul Traum Occupat Eye Dis, 2022,44(6):406-411. 

[12] Zhu L, Chen X, Yan L, 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.

[13] Chen Q, He J, Hu G, et al. Morphological Characteristics and Risk Factors of Myopic Maculopathy in an Older High Myopia Population-Based on the New Classification System (ATN)[J]. Am J Ophthalmol,2019,208:356-366. 

[14] Ruiz-Medrano J, Flores-Moreno I, Ohno-Matsui K, et al. Correlation Between Atrophy-Traction-Neovascularization Grade For Myopic Maculopathy And Clinical Severity[J]. Retina,2021,41(9):1867-1873.

[15] Todorich B, Scott I U, Flynn H J, et al. Macular retinoschisis associated with pathologic myopia[J]. Retina, 2013,33(4):678-683. 

[16] Vogt D, Stefanov S, Guenther S R, et al. Comparison of Vitreomacular Interface Changes in Myopic Foveoschisis and Idiopathic Epiretinal Membrane Foveoschisis[J]. Am J Ophthalmol,2020,217:152-161. 

[17] Liu X L , Yu Q , Yang J H ,et al.Analysis on low vision and blindness in high myopic patients[J]. International Eye Science, 2016,16(9): 4.

[18] Chen YR, Li XX, Li MH..Imaging etiology of pathological myopia results in visual impairment [J].Chin J Exp Ophthalmol , 39(6):528-533. 

[19] Fang, Yuxin., Du, Ran., Nagaoka, Natsuko., Yokoi, Tae., Shinohara, Kosei.  OCT-Based Diagnostic Criteria for Different Stages of Myopic Maculopathy[J]. Ophthalmology, 2019, 126(7):1018-1032.  

[20] Oishi A, Yamashiro K, Tsujikawa A, Ooto S, Tamura H, Nakata I, Miyake M, Yoshimura N. Long-term effect of intravitreal injection of anti-VEGF agent for visual acuity and chorioretinal atrophy progression in myopic choroidal neovascularization[J]. Graefes Arch Clin Exp Ophthalmol. 2013 Jan;251(1):1-7. 

[21] Benhamou N, Massin P, Haouchine B, et al. Macular retinoschisis in highly myopic eyes[J]. Am J Ophthalmol,2002,133(6):794-800.

[22] Machado N T, de Souza C D, Isenberg J, et al. Stellate nonhereditary idiopathic foveomacular retinoschisis resolution after vitreomacular adhesion release[J]. Am J Ophthalmol Case Rep, 2021, 23: 101153. 

[23] Polascik B W, Zhang W, Grewal D S, et al. Spontaneous improvement of myopic macular retinoschisis: case report and review of literature[J]. Can J Ophthalmol,2017,52(1): e11-e13. 

[24] Fang D, Su J, Chen L, et al. The Role of Internal Limiting Membrane as a Biomarker in the Evolution of Myopic Traction Maculopathy[J]. Front Med (Lausanne),2021,8:802626. 

[25] Sadda S R, Abdelfattah N S, Lei J, et al. Spectral-Domain OCT Analysis of Risk Factors for Macular Atrophy Development in the HARBOR Study for Neovascular Age-Related Macular Degeneration[J]. Ophthalmology,2020,127(10):1360-1370.

[26] Holm K, Larsson J, Lovestam-Adrian M. In diabetic retinopathy, foveal thickness of 300 mum seems to correlate with functionally significant loss of vision[J]. Doc Ophthalmol,2007,114(3):117-124.

[27] Garcia-Ben A, Baquero-Aranda I, Garcia-Basterra I, et al. Relationship Between Integrity Of Henle Fibers And Visual Acuity In Myopic Foveoschisis [J]. Retina, 2022, 42(4): 689-696. 

[28] Igarashi-Yokoi T, Shinohara K, Fang Y, et al. Prognostic Factors for Axial Length Elongation and Posterior Staphyloma in Adults With High Myopia: A Japanese Observational Study[J]. Am J Ophthalmol,2021,225:76-85. 

[29] Shimada N, Ohno-Matsui K, Baba T, et al. Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment[J]. Am J Ophthalmol, 2006, 142(3):497-500.