Management of Specific Diseases Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Myopic Traction Maculopathy María Gómez-Resa · Anniken Burés-Jelstrup · Carlos Mateo Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
Myopic traction maculopathy is a high myopia-related complication caused by several mechanisms with traction as a common pathway. Macular hole-related retinal detachment is considered to be the final stage of progressive foveoschisis. In this setting, release of all vitreous and epiretinal tractions is essential in order to achieve surgical success. Pars plana vitrectomy has proven useful in the treatment of myopic foveoschisis, with both good visual and anatomical results. However, the surgical technique for the treatment of macular hole-related retinal detachment is still a controversial issue: reoperations are common and the final visual prognosis is limited, especially in those cases with a pronounced posterior staphyloma. We must also bear in mind that a highly myopic eye has some characteristic traits that may complicate vitreoretinal surgery. In these cases, microincision vitrectomy surgery may offer some advantages compared to conventional © 2014 S. Karger AG, Basel vitrectomy.
The term ‘myopic traction maculopathy’ was proposed by Panozzo and Mercanti [1] to encompass various findings by optical coherence tomography (OCT) in highly myopic eyes, all with traction in common. Among these findings, tangen-
tial premacular vitreous traction [2–8], stretched retinal vessels [8, 9], the presence of epiretinal membranes [9], an abnormally rigid inner limiting membrane [1, 10, 11], and the posterior staphyloma [2, 3] have been described. Progressive traction of these structures will determine the evolution of myopic traction maculopathy [3]. Myopic foveoschisis (MF) often represents an initial stage of a macular hole retinal detachment (MHRD), especially in cases with associated foveal detachment [12–14]. Myopic Foveoschisis
MF has recently been described [2], thanks to the advances in OCT imaging. Since the introduction of OCT in clinical practice, the incidence of MF has been reported to range between 9 and 34% in highly myopic eyes with a posterior staphyloma [1, 7]. Back in 1958, Phillips [15] was the first to describe a retinal elevation within the posterior pole in the absence of a macular hole (MH), possibly explained by retinal schisis (fig. 1). In some cases, biomicroscopy shows epiretinal membranes or pseudomacular holes [16]. Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
Abstract
Fig. 1. MF and foveal detachment.
progression of the disease [19]. A previous history of MHRD in the other eye should also be taken into account [4, 12]. Surgery seems to play a prophylactic role in cases with associated foveal detachment or lamellar MH and helps to prevent progression towards a MH [4], with or without retinal detachment, which has a poorer visual and anatomic prognosis. Surgical Technique The principal role of vitrectomy is to remove all intraocular vitreoretinal tractions. Microincision vitrectomy surgery has potential advantages compared to conventional vitrectomy in highly myopic eyes, especially since the thin sclera of these eyes may lead to several intraoperative complications. Microcannulas have shown a reduction of the incidence of iatrogenic peripheral breaks [20]. The valved microcannula systems prevent uncontrolled intraocular pressure changes, which may induce pupil closure or even intraoperative choroidal detachment. Despite the lower range of complications with the small-gauge system, visu-
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
205
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
OCT is the gold standard for the diagnosis of MF and allows one to quantify the degree of schisis and its longitudinal progression. Other associated features depicted by OCT are epiretinal tractions, inner and outer retinal defects (lamellar holes), and foveal detachments (fig. 2). A thorough OCT examination of the posterior pole, searching for paravascular or peripapillary retinal breaks, or breaks close to atrophic areas, should be performed before establishing a definite diagnosis of MF [14]. These types of breaks are typically infradiagnosed since they tend to be missed in biomicroscopic examination, which can ultimately lead to surgical failure. MF tends to remain both anatomically and functionally stable for long periods of time [3, 17], and even sporadic cases of spontaneous resolution have been described [18]. As a general rule, visual acuity tends to decline when the fovea detaches [2, 17], although functional and anatomical status are not always directly correlated [16]. Surgery is usually considered when there is visual loss and/or metamorphopsia attributed to the
a
b
c
d
Fig. 2. a Progressive retinoschisis. b Retinoschisis and foveal detachment with clear epiretinal traction. c Foveal detachment and inner lamellar MH. d Full-thickness MH hole with schisis.
206
anatomical and functional results [8, 19] even in eyes with a pronounced posterior staphyloma [8]. This suggests that ILM peeling is not essential for this purpose. The rationale behind ILM removal is to reduce macular traction causing foveoschisis and foveal detachment [12, 23], and also to confirm removal of all epiretinal tissue [13]. On the other hand, ILM removal favors retinal elongation in order to adapt to the posterior staphyloma, although the absence of ILM results in a more fragile retina [24]. ILM peeling is performed with forceps and is usually previously stained with indocyanine green, trypan blue, or brilliant blue [12, 13] (fig. 3). Due to the inherent traits of highly myopic eyes, it is advisable to stain more than once in
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
al results show no differences with the two techniques [21]. The use of triamcinolone or trypan blue improves visualization of the vitreous during surgery [6, 12] since posterior vitreous schisis and firmly adhered vitreous cortex on the retinal surface [13] are common findings in myopic eyes. Both forceps and the Tano diamond dust scraper are recommended to remove all vitreous remnants. The length of the forceps and other surgical instruments must be chosen carefully since axial lengths of 30 mm or more are not uncommon in these highly myopic eyes [22]. Internal limiting membrane (ILM) peeling is a controversial issue [6]. Some case series of vitrectomy without ILM peeling have reported good
using macular buckling combined with vitrectomy (fig. 4). When associated with a MH, combined vitrectomy and macular buckling achieves a 100% rate of MH closure, and visual improvement in 81% of patients [29].
order to confirm a complete removal of the ILM. ILM peeling is difficult and associated with multiple complications in highly myopic eyes. The ILM in myopes is thin, sticky, and tends to break constantly during its removal [25]. The use of gas in these cases remains controversial. Panozzo and Mercanti [13] published a report of 24 cases treated with vitrectomy without gas tamponade, and obtained slow but progressive anatomic resolution. The role of gas tamponade after fluid-air exchange is also uncertain [4, 6] since anatomic resolution usually occurs after the gas has cleared out [8]. The most commonly used gas tamponades are perfluoropropane [6] or sulfur hexafluoride [4] at a nonexpansile concentration. Face-down positioning is required for a period of 24 h to 2 weeks postoperatively [4, 8]. In eyes with foveal detachment, the gas may push the subretinal fluid inside the limited area of the posterior staphyloma and towards the weak point of the fovea, causing the formation of a MH [12]. Hirakata and Hida [12] suggested using silicone oil tamponade in cases with a poor vision in the opposite eye. In 2006, Baba et al. [26] used macular buckling alone to treat cases with foveoschisis and foveal detachment, achieving a visual improvement of two or more lines in 66% of the eyes. Mateo et al. [27, 28] showed similar results in a large series
Complications MH development after vitrectomy is one of the most feared complications in patients with foveoschisis [4, 12]. The incidence of MH development is variable (0–27%) [16, 34], but in all cases visual acuity tends to decline [4, 12]. Foveoschisis cases with associated severe foveal detach-
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
207
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
Fig. 3. ILM peeling.
Results OCT is a fundamental tool in the postoperative follow-up [4]. Both foveoschisis and foveal detachment tend to improve immediately after surgery and then more gradually over the next 6–12 months [4, 13]. This is the natural course for 75– 100% of cases [4, 6, 30], which tend to remain stable once improvement has occurred [12]. Some factors are associated with a worse surgical outcome, such as degenerative myopic fundus alterations [16], a severe posterior staphyloma, and a thin choroid [30]. In some series, up to 70% of patients with associated foveal detachment showed visual improvement compared to only 42% of the patients without associated foveal detachment [31, 32]. Both a postoperative decrease of the central macular thickness and integrity of the inner segment/outer segment junction are associated with a better visual outcome [33]. Kim et al. [31] compared visual outcomes in patients who received a gas tamponade after vitrectomy and ILM peeling with those who did not, and found no statistically significant differences between the two groups in terms of visual gain (55.6 vs. 62.5%) or foveoschisis resolution (88.9 vs. 75%). The only significant difference encountered in their study was faster resolution of the foveoschisis in the patients treated with a gas tamponade (2.25 vs. 4.5 months).
a
b
c
d
Fig. 4. a High myopia with posterior staphyloma. b Full-thickness MH with retinoschisis. c Macular buckling. d Postoperative spectral domain OCT after combined macular buckling and pars plana vitrectomy.
208
Macular Hole Retinal Detachment
MHRD is a severe retinal complication that almost exclusively occurs in highly myopic eyes with a pronounced posterior staphyloma. Various surgical techniques have been used throughout time, such as diathermy, pneumoretinopexy, scleral shortening, and macular buckling. Gonvers and Machemer [37] were the first to describe the use of vitrectomy with gas-fluid exchange for this purpose in 1982. Since then, several reports have been published describing variations of the vitrectomy technique, using silicone oil tamponade, ILM peeling, inverted ILM flap technique, laser around the MH, or a buckle as adjunctive treatment (encircling or macular buckle) [38, 39] (fig. 5). The overall surgical success rate in MHRD is poorer
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
ment [12] as well as eyes with a preoperative inner segment/outer segment junction defect [35] are more prone to MH development after surgery. Shimada et al. [36] suggested a fovea-sparing ILM peeling technique to avoid iatrogenic MH development (fovea sparing group 0%; complete ILM peeling group 16.7%). Another complication is the recurrence of the foveal detachment, due to an incomplete removal of the vitreoretinal tractions [12]. Cataract progression after vitrectomy is also a known surgical complication. Thus, combined phacoemulsification with intraocular lens implantation and vitrectomy is a widely accepted surgical option to avoid having to perform another surgical procedure [6, 19].
a
b
c
d
Fig. 5. a MHRD; liquid perfluorocarbon injection over the posterior pole. b ILM peeling using a 23-gauge microsurgical forceps; liquid perfluorocarbon can facilitate peeling of the membrane without exertion of excessive retinal traction. c Macular buckle under the macular area. d Illuminated macular buckle with an internal 30-gauge chandelier optical fiber; this technique allows placing it correctly under the fovea.
studies have shown better anatomic results after ILM peeling [41, 42] since this guarantees complete removal of all epiretinal tractions and a more flexible retina [41]. The dyes used in vitreoretinal surgery are potentially toxic. Thus, the combination of the dye with a viscoelastic substance may help to prevent migration into the subretinal space through the MH. Kadonosono et al. [41] used a viscoelastic material containing indocyanine green to stain the ILM. Another option is to place a small drop of perfluorocarbon liquid over the MH before using the dye; however, the complex anatomy of the posterior staphyloma can turn this procedure into a challenging one [43].
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
209
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
than in conventional rhegmatogenous retinal detachment, and reoperations are often necessary [38]. There is no standard technique for the treatment of MHRD, and as for MF [36, 39], OCT is key both in the diagnosis and as a follow-up tool. The main causative factors in MHRD are vitreous and retinal tractions over the macular area; therefore, its removal is crucial. Fang et al. [40] achieved up to 88% retinal reattachment after one surgery in 34 eyes, removing all epiretinal tissue and posterior hyaloid assisted with triamcinolone. Most patients also showed an improvement in visual acuity without an increase in intraocular pressure. However, MH closure could only be confirmed by OCT in 46% of the patients. Other
Gas or Silicone Oil? According to Mancino et al. [44], C3F8 tamponade after vitrectomy and ILM peeling offers better results, both functional and anatomic, than silicone oil. Silicone oil offers some advantages, such as faster visual recovery and a long-acting tamponade effect, and is therefore preferred for patients who are unable to remain in a facedown position. The drawback of silicone oil is that, due to its toxicity and elevation of intraocular pressure, it will have to be removed in most patients, requiring a new surgical procedure with its potential complications. Mete et al. [45] found similar results in terms of visual gain and retinal reapplication for both 1,000 cSt silicone oil and heavy silicone oil, retrospectively. On the other hand, Avitabile et al. [46] defended the use of Densiron as the tamponade of choice, maintaining retinal reapplication in 87% of the cases after Densiron extraction compared to 53% after standard silicone oil extraction. A fundamental step when using microincision vitrectomy surgery is choosing a low-viscosity silicone oil to facilitate both injection and extraction. Photocoagulation around the Macular Hole? Kwok et al. [47] found no visual or anatomic differences between endolaser around the MH or no laser associated with vitrectomy and gas tamponade. On the other hand, Yu et al. [48] found that patients treated with laser showed better visual results than those who did not receive laser treatment during the vitrectomy (100 vs. 53.8% improvement). Laser is a destructive treatment that may increase the size of previous
scar tissue and limit visual prognosis. Therefore, it should only be used in eyes with a poor visual prognosis. Combined Scleral Buckle? Given the results of Ghoraba et al. [49], the use of a 360° encircling band in combination with pars plana vitrectomy and silicone oil offers no additional effect on either the anatomical success or the rate of MH closure in the management of myopic MHRD. Macular Buckling? Macular buckling is a surgical technique that pretends to counteract the pulling effect of the progressive staphyloma. Different techniques have been used together with modern vitrectomy techniques [50–52]. Pars plana vitrectomy is useful for removing two of the main tractions that cause myopic traction maculopathy: vitreous traction and an abnormally rigid ILM. However, vitrectomy does not address the pulling effect exerted by the stretched retinal vessels nor the posterior staphyloma. Macular buckling offers better visual and anatomic results in cases of MHRD in eyes with a high axial length since it is capable of addressing a major cause of traction over the macula: posterior staphyloma [53]. MH closure in eyes with high axial length is difficult to obtain by vitrectomy alone due to the disproportion between the retina and the pronounced staphyloma [42]. Alkabes et al. [52] obtained excellent anatomic and visual outcomes in the treatment of MHRD with macular buckling. Though the results were positive in previously vitrectomized eyes as well as untreated eyes, the results were superior when macular buckling was the first-choice technique.
References
210
2 Takano M, Kishi S: Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma. Am J Ophthalmol 1999;128:472–476.
3 Benhamou N, Massin P, Haouchine B, Erginay A, Gaudric A: Macular retinoschisis in highly myopic eyes. Am J Ophthalmol 2002;133:794–800.
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
1 Panozzo G, Mercanti A: Optical coherence tomography findings in myopic traction maculopathy. Arch Ophthalmol 2004;122:1455–1460.
17 Baba T, Ohno-Matsui K, Futagami S, et al: Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia. Am J Ophthalmol 2003;135:338–342. 18 Polito A, Lanzetta P, Del Borrello M, et al: Spontaneous resolution of a shallow detachment of the macula in a highly myopic eye. Am J Ophthalmol 2003;135: 546–547. 19 Kwok KH, Lai TY, Yip WW: Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis. Br J Ophthalmol 2005;89: 1180–1183. 20 Cha DM, Woo SJ, Park KH, Chung H: Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy. Graefes Arch Clin Exp Ophthalmol 2013;251:1469– 1474. 21 Ikuno Y, Asai T, Yano S, Nishida K: Small gauge vitrectomy in macular surgery for myopic complications (in Japanese). Nihon Ganka Gakkai Zasshi 2012;116:1130–1136. 22 Gao X, Ikuno Y, Nishida Y: Long-shaft forceps for membrane peeling in highly myopic eyes. Retina 2013;33:1475–1476. 23 Kuhn F: Internal limiting membrane removal for macular detachment in highly myopic eyes. Am J Ophthalmol 2003;135:547–549. 24 Wollensak G, Spoerl E, Grosse G, Wirbelauer C: Biomechanical significance of the human internal limiting lamina. Retina 2006;26:965–968. 25 Kwok AK, Lai TY: Internal limiting membrane removal in macular hole surgery of severely myopic eyes: a case-control study. Br J Ophthalmol 2003;87: 885–889. 26 Baba T, Tanaka S, Maesawa A, Teramatsu T, Noda Y, Yamamoto S: Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole. Am J Ophthalmol 2006;142:483– 487. 27 Mateo C, Gómez-Resa MV, Burés-Jelstrup A, Alkabes M: Surgical outcomes of macular buckling techniques for macular retinoschisis in highly myopic eyes. Saudi J Ophthalmol 2013;27:235–239. 28 Mateo C, Burés-Jelstrup A, Navarro R, Corcóstegui B: Macular buckling for eyes with myopic foveoschisis secondary to posterior staphyloma. Retina 2012;32: 1121–1128.
29 Burés-Jelstrup A, Alkabes A, GómezResa M, Ríos J, Corcóstegui B, Mateo C: Visual and anatomical outcome after macular buckling for macular hole with associated foveoschisis in highly myopic eyes. Br J Ophthalmol 2014;98: 104–109. 30 Iida Y, Hangai M, Yoshikawa M, Ooto S, Yoshimura N: Local biometric features and visual prognosis after surgery for treatment of myopic foveoschisis. Retina 2013;33:1179–1187. 31 Kim KS, Lee SB, Lee WK: Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis. Am J Ophthalmol 2012;153:320–326. 32 Ikuno Y, Sayanagi K, Soga K, Oshima Y, Ohji M, Tano Y: Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis. Jpn J Ophthalmol 2008;52:269–276. 33 Fujimoto S, Ikuno Y, Nishida K: Postoperative optical coherence tomographic appearance and relation to visual acuity after vitrectomy for myopic foveoschisis. Am J Ophthalmol 2013;156:968– 973. 34 Gaucher D, Haouchine B, Tadayoni R, Massin P, Erginay A, Benhamou N, Gaudric A: Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome. Am J Ophthalmol 2007;143:455–462. 35 Gao X, Ikuno Y, Fujimoto S, Nishida K: Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis. Am J Ophthalmol 2013; 155: 1021–1027. 36 Shimada N, Sugamoto Y, Ogawa M, Takese H, Ohno-Matsui K: Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol 2012;154:693–701. 37 Gonvers M, Machemer R: A new approach to treating retinal detachment with macular hole. Am J Ophthalmol 1982;94:468–472. 38 Ortisi E, Avitabile T, Bonfiglio V: Surgical management of retinal detachment because of macular hole in highly myopic eyes. Retina 2012;32:1704–1718. 39 Kuriyama S, Hayashi H, Jingami Y, Kuramoto N, Akita J, Matsumoto M: Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia. Am J Ophthalmol 2013; 156: 125– 131.
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
211
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
4 Kobayashi H, Kishi S: Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. Ophthalmology 2003;110:1702–1707. 5 Ishida M, Yamazaki K, Shinoda K, et al: Macular hole retinal detachment in highly myopic eyes: ultrastructure of surgically removed epiretinal membrane and clinicopathologic correlation. Retina 2000;20:176–183. 6 Ikuno Y, Sayanagi K, Ohji M, Kamei M, Gomi F, Harino S, Fujikado T, Tano Y: Vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Am J Ophthalmol 2004;137:719–724. 7 Akiba J, Konno S, Sato E, et al: Retinal detachment and retinoschisis detected by optical coherence tomography in a myopic eye with macular hole. Ophthalmic Surg Lasers 2003;31:240–242. 8 Yeh SI, Chang WC, Chen LJ: Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes. Acta Ophthalmol 2008;86:219–224. 9 Ikuno Y, Gomi F, Tano Y: Potent retina arteriolar traction as possible cause of myopic foveoschisis. Am J Ophthalmol 2005;139:462–467. 10 Bando H, Ikuno Y, Choi JS, Tano Y, Yamanaka I, Ishibashi T: Ultrastructure of internal limiting membrane in myopic foveoschisis. Am J Ophthalmol 2005; 391:197–199. 11 Sayanagi K, Ikuno Y, Tano Y: Tractional internal limiting membrane detachment in highly myopic eyes. Am J Ophthalmol 2006;142:850–852. 12 Hirakata A, Hida T: Vitrectomy for myopic posterior retinoschisis or foveal detachment. Jpn J Ophthalmol 2006;50: 53–61. 13 Panozzo G, Mercanti A: Vitrectomy for myopic traction maculopathy. Arch Ophthalmol 2005;125:767–772. 14 Smiddy WE, Kim SS, Lujan BJ, Gregori D: Myopic traction maculopathy: spectral domain optical coherence tomographic imaging and a hypothesized mechanism. Ophthalmic Surg Lasers Imaging 2009;40:169–173. 15 Phillips CI: Retinal detachment at the posterior pole. Br J Ophthalmol 1958;42: 749–753. 16 Kanda S, Uemura A, Sakamoto Y, Kita H: Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes. Am J Ophthalmol 2003;136:177–180.
40 Fang X, Weng Y, Xu S, Chen Z, Liu J, Chen B, Wu P, Ni H, Yao K: Optical coherence tomographic characteristics and surgical outcome of eyes with myopic foveoschisis. Eye 2009;23:1336–1342. 41 Kadonosono K, Yazama F, Itoh N, Uchio E, Nakamura S, Akura J, Sawada H, Ohno S: Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal. Am J Ophthalmol 2001;131: 203–207. 42 Ichibe M, Yoshizaka T, Murakami K, Ohta M, Oya Y, Yamamoto S, Funaki S, Funaki H, Ozawa Y, Baba E, Abe H: Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula. Am J Ophthalmol 2003;136: 277–284. 43 Facino M, Mochi B, Lai S, Terrile R: A simple way to prevent indocyanine green from entering the subretinal space during vitrectomy for retinal detachment due to myopic macular hole. Eur J Ophthalmol 2004;14:269–271.
44 Mancino R, Ciuffoletti E, Martucci A, Aiello F, Cedrone C, Cerulli L, Nucci C: Anatomical and functional results of macular hole retinal detachment surgery in patients with high myopia and posterior staphyloma treated with perfluoropropane gas or silicone oil. Retina 2013; 33:586–592. 45 Mete M, Parolini B, Maggio E, Pertile G: 1000 cSt silicone oil vs heavy silicone oil as intraocular tamponade in retinal detachment associated to myopic macular hole. Graefes Arch Clin Exp Ophthalmol 2001;249:821–826. 46 Avitabile T, Bonfiglio V, Buccoliero D, Castiglione F, Reibaldi M, Castaing M, Mistretta A: Heavy versus standard silicone oil in the management of retinal detachment with macular hole in myopic eyes. Retina 2011;31:540–546. 47 Kwok A, Cheng L, Gopal L, Sharma T, Lam D: Endolaser around macular hole in the management of associated retinal detachment in highly myopic eyes. Retina 2000;20:439–444. 48 Yu J, Wang F, Cao H, Fan Y, Zhang X: Combination of internal limiting membrane peeling and endophotocoagulation for retinal detachment related to high myopia in patients with macular hole. Ophthalmic Surg Lasers Imaging 2010;41:215–221.
49 Ghoraba HH, Mansour HO, Elgouhary SM: Effect of 360° episcleral band as adjunctive to pars plana vitrectomy and silicone oil tamponade in the management of myopic macular hole retinal detachment. Retina 2013;0:1–9. 50 Mitamura Y, Takeuchi S, Tsuruoka M: Macular buckling combined with pars plana vitrectomy for complicated retinal detachment due to macular hole. Retina 2000;20:669–672. 51 El Rayes EN: Supra choroidal buckling in managing myopic vitreoretinal interface disorders: 1-year data. Retina 2014; 34:129–135. 52 Alkabes M, Burés-Jelstrup A, Salinas C, Dutra Medeiros M, Rios J, Corcóstegui B, Mateo C: Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study. Graefes Arch Clin Exp Ophthalmol 2014;252:571–581. 53 Ripandelli G, Coppé AM, Fedeli R, Pairi V, D’Amico DJ, Stirpe M: Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes. Ophthalmology 2001;108: 2258–2265.
212
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
Carlos Mateo Instituto de Microcirugía Ocular (IMO) C/Josep María Lladó, No. 3 ES–08035 Barcelona (Spain) E-Mail [email protected]
Myopic Traction Maculopathy María Gómez-Resa · Anniken Burés-Jelstrup · Carlos Mateo Instituto de Microcirugía Ocular (IMO), Barcelona, Spain
Myopic traction maculopathy is a high myopia-related complication caused by several mechanisms with traction as a common pathway. Macular hole-related retinal detachment is considered to be the final stage of progressive foveoschisis. In this setting, release of all vitreous and epiretinal tractions is essential in order to achieve surgical success. Pars plana vitrectomy has proven useful in the treatment of myopic foveoschisis, with both good visual and anatomical results. However, the surgical technique for the treatment of macular hole-related retinal detachment is still a controversial issue: reoperations are common and the final visual prognosis is limited, especially in those cases with a pronounced posterior staphyloma. We must also bear in mind that a highly myopic eye has some characteristic traits that may complicate vitreoretinal surgery. In these cases, microincision vitrectomy surgery may offer some advantages compared to conventional © 2014 S. Karger AG, Basel vitrectomy.
The term ‘myopic traction maculopathy’ was proposed by Panozzo and Mercanti [1] to encompass various findings by optical coherence tomography (OCT) in highly myopic eyes, all with traction in common. Among these findings, tangen-
tial premacular vitreous traction [2–8], stretched retinal vessels [8, 9], the presence of epiretinal membranes [9], an abnormally rigid inner limiting membrane [1, 10, 11], and the posterior staphyloma [2, 3] have been described. Progressive traction of these structures will determine the evolution of myopic traction maculopathy [3]. Myopic foveoschisis (MF) often represents an initial stage of a macular hole retinal detachment (MHRD), especially in cases with associated foveal detachment [12–14]. Myopic Foveoschisis
MF has recently been described [2], thanks to the advances in OCT imaging. Since the introduction of OCT in clinical practice, the incidence of MF has been reported to range between 9 and 34% in highly myopic eyes with a posterior staphyloma [1, 7]. Back in 1958, Phillips [15] was the first to describe a retinal elevation within the posterior pole in the absence of a macular hole (MH), possibly explained by retinal schisis (fig. 1). In some cases, biomicroscopy shows epiretinal membranes or pseudomacular holes [16]. Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
Abstract
Fig. 1. MF and foveal detachment.
progression of the disease [19]. A previous history of MHRD in the other eye should also be taken into account [4, 12]. Surgery seems to play a prophylactic role in cases with associated foveal detachment or lamellar MH and helps to prevent progression towards a MH [4], with or without retinal detachment, which has a poorer visual and anatomic prognosis. Surgical Technique The principal role of vitrectomy is to remove all intraocular vitreoretinal tractions. Microincision vitrectomy surgery has potential advantages compared to conventional vitrectomy in highly myopic eyes, especially since the thin sclera of these eyes may lead to several intraoperative complications. Microcannulas have shown a reduction of the incidence of iatrogenic peripheral breaks [20]. The valved microcannula systems prevent uncontrolled intraocular pressure changes, which may induce pupil closure or even intraoperative choroidal detachment. Despite the lower range of complications with the small-gauge system, visu-
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
205
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
OCT is the gold standard for the diagnosis of MF and allows one to quantify the degree of schisis and its longitudinal progression. Other associated features depicted by OCT are epiretinal tractions, inner and outer retinal defects (lamellar holes), and foveal detachments (fig. 2). A thorough OCT examination of the posterior pole, searching for paravascular or peripapillary retinal breaks, or breaks close to atrophic areas, should be performed before establishing a definite diagnosis of MF [14]. These types of breaks are typically infradiagnosed since they tend to be missed in biomicroscopic examination, which can ultimately lead to surgical failure. MF tends to remain both anatomically and functionally stable for long periods of time [3, 17], and even sporadic cases of spontaneous resolution have been described [18]. As a general rule, visual acuity tends to decline when the fovea detaches [2, 17], although functional and anatomical status are not always directly correlated [16]. Surgery is usually considered when there is visual loss and/or metamorphopsia attributed to the
a
b
c
d
Fig. 2. a Progressive retinoschisis. b Retinoschisis and foveal detachment with clear epiretinal traction. c Foveal detachment and inner lamellar MH. d Full-thickness MH hole with schisis.
206
anatomical and functional results [8, 19] even in eyes with a pronounced posterior staphyloma [8]. This suggests that ILM peeling is not essential for this purpose. The rationale behind ILM removal is to reduce macular traction causing foveoschisis and foveal detachment [12, 23], and also to confirm removal of all epiretinal tissue [13]. On the other hand, ILM removal favors retinal elongation in order to adapt to the posterior staphyloma, although the absence of ILM results in a more fragile retina [24]. ILM peeling is performed with forceps and is usually previously stained with indocyanine green, trypan blue, or brilliant blue [12, 13] (fig. 3). Due to the inherent traits of highly myopic eyes, it is advisable to stain more than once in
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
al results show no differences with the two techniques [21]. The use of triamcinolone or trypan blue improves visualization of the vitreous during surgery [6, 12] since posterior vitreous schisis and firmly adhered vitreous cortex on the retinal surface [13] are common findings in myopic eyes. Both forceps and the Tano diamond dust scraper are recommended to remove all vitreous remnants. The length of the forceps and other surgical instruments must be chosen carefully since axial lengths of 30 mm or more are not uncommon in these highly myopic eyes [22]. Internal limiting membrane (ILM) peeling is a controversial issue [6]. Some case series of vitrectomy without ILM peeling have reported good
using macular buckling combined with vitrectomy (fig. 4). When associated with a MH, combined vitrectomy and macular buckling achieves a 100% rate of MH closure, and visual improvement in 81% of patients [29].
order to confirm a complete removal of the ILM. ILM peeling is difficult and associated with multiple complications in highly myopic eyes. The ILM in myopes is thin, sticky, and tends to break constantly during its removal [25]. The use of gas in these cases remains controversial. Panozzo and Mercanti [13] published a report of 24 cases treated with vitrectomy without gas tamponade, and obtained slow but progressive anatomic resolution. The role of gas tamponade after fluid-air exchange is also uncertain [4, 6] since anatomic resolution usually occurs after the gas has cleared out [8]. The most commonly used gas tamponades are perfluoropropane [6] or sulfur hexafluoride [4] at a nonexpansile concentration. Face-down positioning is required for a period of 24 h to 2 weeks postoperatively [4, 8]. In eyes with foveal detachment, the gas may push the subretinal fluid inside the limited area of the posterior staphyloma and towards the weak point of the fovea, causing the formation of a MH [12]. Hirakata and Hida [12] suggested using silicone oil tamponade in cases with a poor vision in the opposite eye. In 2006, Baba et al. [26] used macular buckling alone to treat cases with foveoschisis and foveal detachment, achieving a visual improvement of two or more lines in 66% of the eyes. Mateo et al. [27, 28] showed similar results in a large series
Complications MH development after vitrectomy is one of the most feared complications in patients with foveoschisis [4, 12]. The incidence of MH development is variable (0–27%) [16, 34], but in all cases visual acuity tends to decline [4, 12]. Foveoschisis cases with associated severe foveal detach-
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
207
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
Fig. 3. ILM peeling.
Results OCT is a fundamental tool in the postoperative follow-up [4]. Both foveoschisis and foveal detachment tend to improve immediately after surgery and then more gradually over the next 6–12 months [4, 13]. This is the natural course for 75– 100% of cases [4, 6, 30], which tend to remain stable once improvement has occurred [12]. Some factors are associated with a worse surgical outcome, such as degenerative myopic fundus alterations [16], a severe posterior staphyloma, and a thin choroid [30]. In some series, up to 70% of patients with associated foveal detachment showed visual improvement compared to only 42% of the patients without associated foveal detachment [31, 32]. Both a postoperative decrease of the central macular thickness and integrity of the inner segment/outer segment junction are associated with a better visual outcome [33]. Kim et al. [31] compared visual outcomes in patients who received a gas tamponade after vitrectomy and ILM peeling with those who did not, and found no statistically significant differences between the two groups in terms of visual gain (55.6 vs. 62.5%) or foveoschisis resolution (88.9 vs. 75%). The only significant difference encountered in their study was faster resolution of the foveoschisis in the patients treated with a gas tamponade (2.25 vs. 4.5 months).
a
b
c
d
Fig. 4. a High myopia with posterior staphyloma. b Full-thickness MH with retinoschisis. c Macular buckling. d Postoperative spectral domain OCT after combined macular buckling and pars plana vitrectomy.
208
Macular Hole Retinal Detachment
MHRD is a severe retinal complication that almost exclusively occurs in highly myopic eyes with a pronounced posterior staphyloma. Various surgical techniques have been used throughout time, such as diathermy, pneumoretinopexy, scleral shortening, and macular buckling. Gonvers and Machemer [37] were the first to describe the use of vitrectomy with gas-fluid exchange for this purpose in 1982. Since then, several reports have been published describing variations of the vitrectomy technique, using silicone oil tamponade, ILM peeling, inverted ILM flap technique, laser around the MH, or a buckle as adjunctive treatment (encircling or macular buckle) [38, 39] (fig. 5). The overall surgical success rate in MHRD is poorer
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
ment [12] as well as eyes with a preoperative inner segment/outer segment junction defect [35] are more prone to MH development after surgery. Shimada et al. [36] suggested a fovea-sparing ILM peeling technique to avoid iatrogenic MH development (fovea sparing group 0%; complete ILM peeling group 16.7%). Another complication is the recurrence of the foveal detachment, due to an incomplete removal of the vitreoretinal tractions [12]. Cataract progression after vitrectomy is also a known surgical complication. Thus, combined phacoemulsification with intraocular lens implantation and vitrectomy is a widely accepted surgical option to avoid having to perform another surgical procedure [6, 19].
a
b
c
d
Fig. 5. a MHRD; liquid perfluorocarbon injection over the posterior pole. b ILM peeling using a 23-gauge microsurgical forceps; liquid perfluorocarbon can facilitate peeling of the membrane without exertion of excessive retinal traction. c Macular buckle under the macular area. d Illuminated macular buckle with an internal 30-gauge chandelier optical fiber; this technique allows placing it correctly under the fovea.
studies have shown better anatomic results after ILM peeling [41, 42] since this guarantees complete removal of all epiretinal tractions and a more flexible retina [41]. The dyes used in vitreoretinal surgery are potentially toxic. Thus, the combination of the dye with a viscoelastic substance may help to prevent migration into the subretinal space through the MH. Kadonosono et al. [41] used a viscoelastic material containing indocyanine green to stain the ILM. Another option is to place a small drop of perfluorocarbon liquid over the MH before using the dye; however, the complex anatomy of the posterior staphyloma can turn this procedure into a challenging one [43].
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
209
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
than in conventional rhegmatogenous retinal detachment, and reoperations are often necessary [38]. There is no standard technique for the treatment of MHRD, and as for MF [36, 39], OCT is key both in the diagnosis and as a follow-up tool. The main causative factors in MHRD are vitreous and retinal tractions over the macular area; therefore, its removal is crucial. Fang et al. [40] achieved up to 88% retinal reattachment after one surgery in 34 eyes, removing all epiretinal tissue and posterior hyaloid assisted with triamcinolone. Most patients also showed an improvement in visual acuity without an increase in intraocular pressure. However, MH closure could only be confirmed by OCT in 46% of the patients. Other
Gas or Silicone Oil? According to Mancino et al. [44], C3F8 tamponade after vitrectomy and ILM peeling offers better results, both functional and anatomic, than silicone oil. Silicone oil offers some advantages, such as faster visual recovery and a long-acting tamponade effect, and is therefore preferred for patients who are unable to remain in a facedown position. The drawback of silicone oil is that, due to its toxicity and elevation of intraocular pressure, it will have to be removed in most patients, requiring a new surgical procedure with its potential complications. Mete et al. [45] found similar results in terms of visual gain and retinal reapplication for both 1,000 cSt silicone oil and heavy silicone oil, retrospectively. On the other hand, Avitabile et al. [46] defended the use of Densiron as the tamponade of choice, maintaining retinal reapplication in 87% of the cases after Densiron extraction compared to 53% after standard silicone oil extraction. A fundamental step when using microincision vitrectomy surgery is choosing a low-viscosity silicone oil to facilitate both injection and extraction. Photocoagulation around the Macular Hole? Kwok et al. [47] found no visual or anatomic differences between endolaser around the MH or no laser associated with vitrectomy and gas tamponade. On the other hand, Yu et al. [48] found that patients treated with laser showed better visual results than those who did not receive laser treatment during the vitrectomy (100 vs. 53.8% improvement). Laser is a destructive treatment that may increase the size of previous
scar tissue and limit visual prognosis. Therefore, it should only be used in eyes with a poor visual prognosis. Combined Scleral Buckle? Given the results of Ghoraba et al. [49], the use of a 360° encircling band in combination with pars plana vitrectomy and silicone oil offers no additional effect on either the anatomical success or the rate of MH closure in the management of myopic MHRD. Macular Buckling? Macular buckling is a surgical technique that pretends to counteract the pulling effect of the progressive staphyloma. Different techniques have been used together with modern vitrectomy techniques [50–52]. Pars plana vitrectomy is useful for removing two of the main tractions that cause myopic traction maculopathy: vitreous traction and an abnormally rigid ILM. However, vitrectomy does not address the pulling effect exerted by the stretched retinal vessels nor the posterior staphyloma. Macular buckling offers better visual and anatomic results in cases of MHRD in eyes with a high axial length since it is capable of addressing a major cause of traction over the macula: posterior staphyloma [53]. MH closure in eyes with high axial length is difficult to obtain by vitrectomy alone due to the disproportion between the retina and the pronounced staphyloma [42]. Alkabes et al. [52] obtained excellent anatomic and visual outcomes in the treatment of MHRD with macular buckling. Though the results were positive in previously vitrectomized eyes as well as untreated eyes, the results were superior when macular buckling was the first-choice technique.
References
210
2 Takano M, Kishi S: Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma. Am J Ophthalmol 1999;128:472–476.
3 Benhamou N, Massin P, Haouchine B, Erginay A, Gaudric A: Macular retinoschisis in highly myopic eyes. Am J Ophthalmol 2002;133:794–800.
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
1 Panozzo G, Mercanti A: Optical coherence tomography findings in myopic traction maculopathy. Arch Ophthalmol 2004;122:1455–1460.
17 Baba T, Ohno-Matsui K, Futagami S, et al: Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia. Am J Ophthalmol 2003;135:338–342. 18 Polito A, Lanzetta P, Del Borrello M, et al: Spontaneous resolution of a shallow detachment of the macula in a highly myopic eye. Am J Ophthalmol 2003;135: 546–547. 19 Kwok KH, Lai TY, Yip WW: Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis. Br J Ophthalmol 2005;89: 1180–1183. 20 Cha DM, Woo SJ, Park KH, Chung H: Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy. Graefes Arch Clin Exp Ophthalmol 2013;251:1469– 1474. 21 Ikuno Y, Asai T, Yano S, Nishida K: Small gauge vitrectomy in macular surgery for myopic complications (in Japanese). Nihon Ganka Gakkai Zasshi 2012;116:1130–1136. 22 Gao X, Ikuno Y, Nishida Y: Long-shaft forceps for membrane peeling in highly myopic eyes. Retina 2013;33:1475–1476. 23 Kuhn F: Internal limiting membrane removal for macular detachment in highly myopic eyes. Am J Ophthalmol 2003;135:547–549. 24 Wollensak G, Spoerl E, Grosse G, Wirbelauer C: Biomechanical significance of the human internal limiting lamina. Retina 2006;26:965–968. 25 Kwok AK, Lai TY: Internal limiting membrane removal in macular hole surgery of severely myopic eyes: a case-control study. Br J Ophthalmol 2003;87: 885–889. 26 Baba T, Tanaka S, Maesawa A, Teramatsu T, Noda Y, Yamamoto S: Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole. Am J Ophthalmol 2006;142:483– 487. 27 Mateo C, Gómez-Resa MV, Burés-Jelstrup A, Alkabes M: Surgical outcomes of macular buckling techniques for macular retinoschisis in highly myopic eyes. Saudi J Ophthalmol 2013;27:235–239. 28 Mateo C, Burés-Jelstrup A, Navarro R, Corcóstegui B: Macular buckling for eyes with myopic foveoschisis secondary to posterior staphyloma. Retina 2012;32: 1121–1128.
29 Burés-Jelstrup A, Alkabes A, GómezResa M, Ríos J, Corcóstegui B, Mateo C: Visual and anatomical outcome after macular buckling for macular hole with associated foveoschisis in highly myopic eyes. Br J Ophthalmol 2014;98: 104–109. 30 Iida Y, Hangai M, Yoshikawa M, Ooto S, Yoshimura N: Local biometric features and visual prognosis after surgery for treatment of myopic foveoschisis. Retina 2013;33:1179–1187. 31 Kim KS, Lee SB, Lee WK: Vitrectomy and internal limiting membrane peeling with and without gas tamponade for myopic foveoschisis. Am J Ophthalmol 2012;153:320–326. 32 Ikuno Y, Sayanagi K, Soga K, Oshima Y, Ohji M, Tano Y: Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis. Jpn J Ophthalmol 2008;52:269–276. 33 Fujimoto S, Ikuno Y, Nishida K: Postoperative optical coherence tomographic appearance and relation to visual acuity after vitrectomy for myopic foveoschisis. Am J Ophthalmol 2013;156:968– 973. 34 Gaucher D, Haouchine B, Tadayoni R, Massin P, Erginay A, Benhamou N, Gaudric A: Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome. Am J Ophthalmol 2007;143:455–462. 35 Gao X, Ikuno Y, Fujimoto S, Nishida K: Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis. Am J Ophthalmol 2013; 155: 1021–1027. 36 Shimada N, Sugamoto Y, Ogawa M, Takese H, Ohno-Matsui K: Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol 2012;154:693–701. 37 Gonvers M, Machemer R: A new approach to treating retinal detachment with macular hole. Am J Ophthalmol 1982;94:468–472. 38 Ortisi E, Avitabile T, Bonfiglio V: Surgical management of retinal detachment because of macular hole in highly myopic eyes. Retina 2012;32:1704–1718. 39 Kuriyama S, Hayashi H, Jingami Y, Kuramoto N, Akita J, Matsumoto M: Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia. Am J Ophthalmol 2013; 156: 125– 131.
Myopic Traction Maculopathy Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
211
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
4 Kobayashi H, Kishi S: Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. Ophthalmology 2003;110:1702–1707. 5 Ishida M, Yamazaki K, Shinoda K, et al: Macular hole retinal detachment in highly myopic eyes: ultrastructure of surgically removed epiretinal membrane and clinicopathologic correlation. Retina 2000;20:176–183. 6 Ikuno Y, Sayanagi K, Ohji M, Kamei M, Gomi F, Harino S, Fujikado T, Tano Y: Vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Am J Ophthalmol 2004;137:719–724. 7 Akiba J, Konno S, Sato E, et al: Retinal detachment and retinoschisis detected by optical coherence tomography in a myopic eye with macular hole. Ophthalmic Surg Lasers 2003;31:240–242. 8 Yeh SI, Chang WC, Chen LJ: Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes. Acta Ophthalmol 2008;86:219–224. 9 Ikuno Y, Gomi F, Tano Y: Potent retina arteriolar traction as possible cause of myopic foveoschisis. Am J Ophthalmol 2005;139:462–467. 10 Bando H, Ikuno Y, Choi JS, Tano Y, Yamanaka I, Ishibashi T: Ultrastructure of internal limiting membrane in myopic foveoschisis. Am J Ophthalmol 2005; 391:197–199. 11 Sayanagi K, Ikuno Y, Tano Y: Tractional internal limiting membrane detachment in highly myopic eyes. Am J Ophthalmol 2006;142:850–852. 12 Hirakata A, Hida T: Vitrectomy for myopic posterior retinoschisis or foveal detachment. Jpn J Ophthalmol 2006;50: 53–61. 13 Panozzo G, Mercanti A: Vitrectomy for myopic traction maculopathy. Arch Ophthalmol 2005;125:767–772. 14 Smiddy WE, Kim SS, Lujan BJ, Gregori D: Myopic traction maculopathy: spectral domain optical coherence tomographic imaging and a hypothesized mechanism. Ophthalmic Surg Lasers Imaging 2009;40:169–173. 15 Phillips CI: Retinal detachment at the posterior pole. Br J Ophthalmol 1958;42: 749–753. 16 Kanda S, Uemura A, Sakamoto Y, Kita H: Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes. Am J Ophthalmol 2003;136:177–180.
40 Fang X, Weng Y, Xu S, Chen Z, Liu J, Chen B, Wu P, Ni H, Yao K: Optical coherence tomographic characteristics and surgical outcome of eyes with myopic foveoschisis. Eye 2009;23:1336–1342. 41 Kadonosono K, Yazama F, Itoh N, Uchio E, Nakamura S, Akura J, Sawada H, Ohno S: Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal. Am J Ophthalmol 2001;131: 203–207. 42 Ichibe M, Yoshizaka T, Murakami K, Ohta M, Oya Y, Yamamoto S, Funaki S, Funaki H, Ozawa Y, Baba E, Abe H: Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula. Am J Ophthalmol 2003;136: 277–284. 43 Facino M, Mochi B, Lai S, Terrile R: A simple way to prevent indocyanine green from entering the subretinal space during vitrectomy for retinal detachment due to myopic macular hole. Eur J Ophthalmol 2004;14:269–271.
44 Mancino R, Ciuffoletti E, Martucci A, Aiello F, Cedrone C, Cerulli L, Nucci C: Anatomical and functional results of macular hole retinal detachment surgery in patients with high myopia and posterior staphyloma treated with perfluoropropane gas or silicone oil. Retina 2013; 33:586–592. 45 Mete M, Parolini B, Maggio E, Pertile G: 1000 cSt silicone oil vs heavy silicone oil as intraocular tamponade in retinal detachment associated to myopic macular hole. Graefes Arch Clin Exp Ophthalmol 2001;249:821–826. 46 Avitabile T, Bonfiglio V, Buccoliero D, Castiglione F, Reibaldi M, Castaing M, Mistretta A: Heavy versus standard silicone oil in the management of retinal detachment with macular hole in myopic eyes. Retina 2011;31:540–546. 47 Kwok A, Cheng L, Gopal L, Sharma T, Lam D: Endolaser around macular hole in the management of associated retinal detachment in highly myopic eyes. Retina 2000;20:439–444. 48 Yu J, Wang F, Cao H, Fan Y, Zhang X: Combination of internal limiting membrane peeling and endophotocoagulation for retinal detachment related to high myopia in patients with macular hole. Ophthalmic Surg Lasers Imaging 2010;41:215–221.
49 Ghoraba HH, Mansour HO, Elgouhary SM: Effect of 360° episcleral band as adjunctive to pars plana vitrectomy and silicone oil tamponade in the management of myopic macular hole retinal detachment. Retina 2013;0:1–9. 50 Mitamura Y, Takeuchi S, Tsuruoka M: Macular buckling combined with pars plana vitrectomy for complicated retinal detachment due to macular hole. Retina 2000;20:669–672. 51 El Rayes EN: Supra choroidal buckling in managing myopic vitreoretinal interface disorders: 1-year data. Retina 2014; 34:129–135. 52 Alkabes M, Burés-Jelstrup A, Salinas C, Dutra Medeiros M, Rios J, Corcóstegui B, Mateo C: Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study. Graefes Arch Clin Exp Ophthalmol 2014;252:571–581. 53 Ripandelli G, Coppé AM, Fedeli R, Pairi V, D’Amico DJ, Stirpe M: Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes. Ophthalmology 2001;108: 2258–2265.
212
Gómez-Resa · Burés-Jelstrup · Mateo Oh H, Oshima Y (eds): Microincision Vitrectomy Surgery. Emerging Techniques and Technology. Dev Ophthalmol. Basel, Karger, 2014, vol 54, pp 204–212 (DOI: 10.1159/000360468)
Downloaded by: Nanyang Technological Univ. 155.69.4.4 - 5/27/2015 6:29:57 PM
Carlos Mateo Instituto de Microcirugía Ocular (IMO) C/Josep María Lladó, No. 3 ES–08035 Barcelona (Spain) E-Mail [email protected]
