![]() Regarding visual outcome, it was found that significant best corrected visual acuity (BCVA) improvement was observed only in eyes with foveal detachment, not in eyes without foveal detachment. ![]() Following surgery, OCT showed complete resolution of myopic foveoschisis in all eyes. Kumagai et al 12 reported the outcomes of PPV with ILM peeling in 39 eyes with myopic foveoschisis. The main goal of surgery is to relieve any abnormal VMT that causes the foveoschisis. 10-13 Surgery is indicated in patients with symptomatic metamorphopsia and progressive visual loss. Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling (with or without gas tamponade) is the main treatment for myopic foveoschisis. Therefore, patients with myopic foveoschisis should be monitored regularly for foveal detachment, and surgical treatment should be considered when foveal detachment develops. In 9 of the 29 eyes, myopic MH developed during the follow-up period 6 of the 9 eyes that developed myopic MH had foveal detachment prior to MH formation. 9 After a mean follow-up of 31.2 months, visual acuity worsened in 20 (69%) eyes and was stable in 9 (31%) eyes. Gaucher et al performed a retrospective review of 29 eyes with myopic foveoschisis. The natural history of myopic foveoschisis is generally poor. Scans from SD-OCT can show splitting of the neurosensory retina and epiretinal membrane associated with vitreomacular traction (VMT Figure 1). However, the small amount of subretinal fluid associated with early stage myopic foveoschisis might be very difficult to detect on fundus examination, and therefore spectral-domain optical coherence tomography (SD-OCT) is extremely useful in the assessment of myopic foveoschisis. Fundus examination might detect mild amount of subretinal fluid in the macula. Patients with myopic foveoschisis might be asymptomatic in the early stage and in the later stage can develop progressive increases in metamorphopsia and visual loss as the foveoschisis progresses. ![]() 8 Abnormal traction caused by posterior hyaloid surface in eyes with posterior staphyloma is the current pathogenesis of myopic foveoschisis. Myopic foveoschisis is the splitting of the retinal layers in the macula, causing accumulation of intraretinal and subretinal fluid at the macula in the absence of a full-thickness macular hole (FTMH). The abnormal contour of the posterior staphyloma results in anatomic changes in the vitreomacular interface, so patients may develop macular pathologies such as myopic foveoschisis and macular hole (MH). MYOPIC FOVEOSCHISISÄue to excessive axial elongation of the globe, patients with high myopia can develop posterior bulging or ectasia of the globe, causing posterior staphyloma. This review aims to provide an overview on the diagnosis and treatment of various macular complications associated with pathologic myopia, including myopic foveoschisis, myopic macular hole, and myopic CNV. Because these macular pathologies in pathologic myopia can result in severe, irreversible visual loss, it is important for ophthalmologists to understand how to manage conditions associated with pathologic myopia. 7 In addition, higher magnitude of refractive error and older age were significantly associated with the presence of posterior pole lesions. 4-6 In a cross-sectional, community-based epidemiologic study conducted in Hong Kong, 11.3% of subjects with high myopia of less than or equal to -6 D were found to have 1 or more posterior pole pathologies. 4 It is well known that individuals with high myopia have increased risks of macular pathologies such as posterior staphyloma, chorioretinal atrophy, RPE atrophy, lacquer cracks, macular hemorrhage, choroidal neovascularization (CNV), myopic foveoschisis, and myopic macular hole. 2 Excessive axial elongation of the eye in pathologic myopia results in mechanical stretching and thinning of the choroid and retinal pigment epithelium (RPE) layers, causing various degenerative changes in the retina. 1,2 Pathologic myopia has a high disease burden, as it has been found to be the first, second, or third most frequent cause of blindness in several population-based studies. 1-3 The prevalence of pathologic myopia varies considerably in different geographic regions and has the highest prevalence in Asian populations. Pathologic myopia is generally defined as globe elongation and a refractive error of at least -6 diopters (D) and/or axial length of greater than 26.5 mm associated with degenerative changes in the retina. ![]() Patients with myopia are likely to develop a number of macular pathologies that, if untreated, will likely lead to blindness.
0 Comments
Leave a Reply. |