Myopic foveoschisis: a clinical review

Abstract

To review the literature on epidemiology, clinical features, diagnostic imaging, natural history, management, therapeutic approaches, and prognosis of myopic foveoschisis. A systematic Pubmed search was conducted using search terms: myopia, myopic, staphyloma, foveoschisis, and myopic foveoschisis. The evidence base for each section was organised and reviewed. Where possible an authors' interpretation or conclusion is provided for each section. The term myopic foveoschisis was first coined in 1999. It is associated with posterior staphyloma in high myopia, and is often asymptomatic initially but progresses slowly, leading to loss of central vision from foveal detachment or macular hole formation. Optical coherence tomography is used to diagnose the splitting of the neural retina into a thicker inner layer and a thinner outer layer, but compound variants of the splits have been identified. Vitrectomy with an internal limiting membrane peel and gas tamponade is the preferred approach for eyes with vision decline. There has been a surge of new information on myopic foveoschisis. Advances in optical coherence tomography will continually improve our understanding of the pathogenesis of retinal splitting, and the mechanisms that lead to macular damage and visual loss. Currently, there is a good level of consensus that surgical intervention should be considered when there is progressive visual decline from myopic foveoschisis.

Complications of Pathologic Myopia

“…The standard diagnostic modality for MF is OCT, which shows the typical splitting of retinal layers, intraretinal cysts, or the bridging columns between the split inner and outer retina. 30,38,39 Other OCT findings include macular hole, epiretinal membrane, retinal microfolds, and the detachment of internal limiting membrane (ILM). 40 Myopic foveoschisis is the most common lesion related to epiretinal traction in degenerative myopia, occurring in 34.4% of eyes.…”

“…2A,B). 38 It has been suggested that MF precedes formation of a macular hole that could eventually lead to retinal detachment. 39 Visual symptoms of MF are often minimal or gradual, 38 and it is not easy to confirm shallow MF on slit-lamp examination.…”

“…38 It has been suggested that MF precedes formation of a macular hole that could eventually lead to retinal detachment. 39 Visual symptoms of MF are often minimal or gradual, 38 and it is not easy to confirm shallow MF on slit-lamp examination. The standard diagnostic modality for MF is OCT, which shows the typical splitting of retinal layers, intraretinal cysts, or the bridging columns between the split inner and outer retina.…”

A Rare Association of Foveoschisis with Gyrate Atrophy

“…[2][3][4] Foveoschisis refers to splitting of the neurosensory retina, and is usually noted in highly myopic patients, Goldman-Favre Syndrome, and those with X-linked retinoschisis. 5 However, the association of foveoschisis with gyrate atrophy is very rare. Herein, we report a 17 year-old female with an unusual appearance on fundus photography and Spectralis optical coherence tomography (OCT): bilateral GA concomitant with foveoschisis.…”

Myopic traction maculopathy

“…1 Panretinal laser photocoagulation (PLP) in peripheral retina has been shown to reduce the VEGF production. 2 Here, we report 1-year results of a prospective randomized single-masked trial comparing 1.25 mg intravitreal bevacizumab pro-re-nata (PRN) monotherapy and PRN therapy in combination with PLP at 1 month in treatment of naive eyes with macular edema (ME) secondary to CRVO.…”