Internal limiting membrane peeling and gas tamponade for myopic foveoschisis: a systematic review and meta-analysis

Abstract

BackgroundMyopic foveoschisis (MF) is among the leading causes of visual loss in high myopia. However, it remains controversial whether internal limiting membrane (ILM) peeling or gas tamponade is necessary treatment option for MF.MethodsPubMed, EMBASE, CBM, CNKI, WANFANG DATA and VIP databases were systematically reviewed. Outcome indicators were myopic foveoschisis resolution rate, visual acuity improvement and postoperative complications.ResultsNine studies that included 239 eyes were selected. The proportion of resolution of foveoschisis was higher in ILM peeling group than non-ILM peeling group (OR = 2.15, 95% CI: 1.06–4.35; P = 0.03). The proportion of postoperative complications was higher in Tamponade group than non-Tamponade group (OR = 10.81, 95% CI: 1.26–93.02; P = 0.03). However, the proportion of visual acuity improvement (OR = 1.63, 95% CI: 0.56–4.80; P = 0.37) between ILM peeling group and non-ILM peeling group and the proportion of resolution of foveoschisis (OR = 1.80, 95% CI: 0.76–4.28; P = 0.18) between Tamponade group and non-Tamponade group were similar.ConclusionsVitrectomy with internal limiting membrane peeling could contribute to better resolution of myopic foveoschisis than non-peeling, however it does not significantly influence the proportion of visual acuity improvement and postoperative complications. Vitrectomy with gas tamponade is associated with more complications than non-tamponade and does not significantly influence the proportion of visual acuity improvement and resolution of myopic foveoschisis.Electronic supplementary materialThe online version of this article (10.1186/s12886-017-0562-8) contains supplementary material, which is available to authorized users.

Vitrectomy with or without internal limiting membrane peeling for myopic foveoschisis

“…Our results demonstrate that, for the treatment of myopic foveoschisis (MF), vitrectomy without internal limiting membrane peeling (ILMP) has similar outcomes to vitrectomy with ILMP. This is consistent with previous reports [4,11]. Indeed, within-cohort statistical analysis showed that significant visual improvement was only achieved in the no-ILMP cohort.…”

“…Myopic foveoschisis (MF) was first described by Takano and Kishi in 1999, and is recognized as one of the major complications associated with pathological myopia [1,2]. Many subsequent studies have demonstrated that vitrectomy with internal limiting membrane peeling (ILMP) can be effective in producing both anatomical and functional improvement in MF [3][4][5][6][7]. In order to reduce postoperative macular hole (MH) formation and foveal damage, a partial ILMP technique with foveal sparing was proposed [8], but there is little evidence that this technique has better outcomes than complete ILMP [9,10] Furthermore, more recent studies have shown similar anatomical and functional improvements can be achieved without any form of IMLP [4,11], casting doubt on the benefits of ILMP.…”

Long-Term Outcome of Vitrectomy with Suitable Internal Limiting Membrane Peeling and Air Tamponade for Highly Myopic Foveoschisis-Associated Lamellar Macular Hole

“…Recently, a meta-analysis [13] reported that gas tamponade might cause more complications compared to vitrectomy without tamponade, although no significant differences were found in the outcomes of visual acuity or in the resolution of myopic foveoschisis. Another report [14] demonstrated a high myopic foveoschisis resolution rate (88%) with intraocular air tamponade.…”

Clinical Management of Myopia in Adults: Treatment of Retinal Complications

“…However, the study showed that the chance of successful resolution was similar between the group with gas tamponade and that without gas tamponade [51]. Indeed, a meta-analysis showed that for eyes undergoing vitrectomy for myopic foveoschisis, gas tamponade did not have significant impact on visual acuity or the rate of resolution of foveoschisis, yet it was associated with more complications [42]. Several studies also reported the paradoxical occurrence of FTHM from the use of gas tamponade, which could squeeze SRF within the limited space through the weak point of fovea [52][53][54].…”

“…For myopic foveoschisis, ILM peeling helps to ensure that all tractional forces from premacular glial cells and vitreous cortex are completely removed [42]. It increases retinal compliance and allows the retina to better conform to the posterior staphyloma [42].…”