Radius of curvature changes in spontaneous improvement of foveoschisis in highly myopic eyes

Abstract

Background Myopic foveoschisis is the splitting of retinal layers overlying staphyloma in highly myopic patients that can lead to vision loss. We assess possible contributing mechanisms to the formation of foveoschisis by examining two cases of spontaneous improvement of myopic foveoschisis and employ a radius of curvature (ROC) measure to track posterior scleral curvature over time. Methods A retrospective, non-comparative case series was performed and optical coherence tomography images were analysed. Retinal pigment epithelial layer ROC was calculated from manually segmented images through the posterior scleral curvature apex. Results Two cases of myopic foveoschisis with foveal detachments in the left eye (OS) were studied. Both patients had high myopia (either <−10 D or >30 mm in axial length). One case occurred in a treatment-naive patient who improved after 4 months of observation. On initial presentation, OS posterior scleral ROC was 12.35 mm and decreased to 12.15 mm at the time of resolution. The other case occurred in a patient who was followed for 7 years, had previously underwent pars plana vitrectomy and removal of epiretinal membrane, experienced recurrence of foveoschisis and then spontaneously improved without further posterior segment surgery. There was an uncomplicated cataract extraction in the interim. Posterior scleral ROC was 4.05 mm on presentation, 4.10 during recurrence, 3.55 mm after cataract extraction and 3.75 mm at resolution. Conclusions Spontaneous improvement of myopic foveoschisis may be due to changes in tractional forces from the internal limiting membrane, cortical vitreous or staphyloma or, alternatively, from a delayed or fluctuant recovery course after intervention.

Prevalence of posterior staphyloma and factors associated with its shape in the Japanese population

“…Quantitative analysis of fundus shape would lead not only to a better understanding of the pathogenesis of staphyloma but also to prediction of its development and progression, as well as give an indication of the prognosis for vision-threatening myopic retinopathies in each patient with high myopia at risk. Previous studies have attempted quantitative analysis of the association between staphyloma and myopic retinopathy by measuring the depth of staphyloma using B-scan ultrasonography 31 , measuring staphyloma depth using OCT 17 , measuring best-fit radius of curvature 32 , or classifying posterior staphyloma 18 . However, grading of B-scan ultrasonography is not suitable for detailed analysis of staphyloma.…”

Morphological Characteristics and Risk Factors of Myopic Maculopathy in an Older High Myopia Population—Based on the New Classification System (ATN)

“…Some patients with severe forms of tractional changes were reported to have a higher risk for progression to FRD, full-thickness MH, and MHRD, which may result in acute substantial visual impairment. [36][37][38] In such patients, early detection and timely surgical intervention could effectively improve their visual acuity and quality of life. Given that the development of MTM has similar important clinical significance, and clinics are now using OCT routinely, a traction component should be considered as a possible component to the myopic macular classification.…”

Vitrectomy and scleral imbrication in patients with myopic traction maculopathy and macular hole retinal detachment

“…We believe that the advantage of sclera imbrication is that it does not require surgical procedures around the macula. In contrast, Hoang and associates [27] reported that the curvature radius of the posterior sclera was reduced after a spontaneous resolution of a macular retinoschisis in highly myopic eyes. They assumed that the decrease of the tractional force from the ILM, vitreous cortex, and staphyloma may be related to the reduced curvature radius of the posterior sclera.…”