Abstract
Purpose
Myopic traction maculopathy (MTM) is the leading cause of visual loss in high myopia. The purpose of this study was to compare the outcomes of pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane (ILM) peeling and complete ILM peeling for MTM.
Methods
A comprehensive literature search was performed to find relevant studies. A meta-analysis was conducted by comparing the weighted mean differences (WMD) in the change of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) from baseline and calculating the odd ratios (OR) for rates of complete reattachment (CR) and postoperative macular hole (MH) formation.
Results
Ten studies were selected, including 417 eyes (172 eyes in the fovea-sparing ILM peeling group (FSIP) and 245 eyes in complete ILM peeling group (CIP)). There was no significant difference in terms of mean change in CFT from baseline and the rate of CR(WMD = 3.53, 95% CI, −25.56 to 32.63, P = 0.81, and OR = 1.41, 95% CI, 0.81 to 2.44, P = 0.22). FSIP was superior to CIP in terms of mean change of logMAR BCVA post operation (WMD = −0.09, 95% CI, −0.15 to −0.03, P = 0.003), and associated with a significantly lower frequency of postoperative MH formation (OR = 0.19, 95% CI, 0.07 to 0.50, P = 0.0008).
Conclusion
FSIP resulted in similar anatomic outcomes compared to CIP, but resulted in better visual acuity and lower rates of postoperative MH development.
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Data availability
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
References
Panozzo G, Mercanti A (2004) Optical coherence tomography findings in myopic traction maculopathy. Arch Ophthalmol 122:1455–1460. https://doi.org/10.1001/archopht.122.10.1455
Panozzo G, Mercanti A (2007) Vitrectomy for myopic traction maculopathy. Arch Ophthalmol 125:767–772. https://doi.org/10.1001/archopht.125.6.767
Gaucher D, Haouchine B, Tadayoni R, Massin P, Erginay A, Benhamou N, Gaudric A (2007) Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome. Am J Ophthalmol 143:455–462. https://doi.org/10.1016/j.ajo.2006.10.053
Shimada N, Ohno-Matsui K, Baba T, Futagami S, Tokoro T, Mochizuki M (2006) Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment. Am J Ophthalmol 142:497–500. https://doi.org/10.1016/j.ajo.2006.03.048
Johnson MW (2012) Myopic traction maculopathy: pathogenic mechanisms and surgical treatment. Retina 32(Suppl 2):S205-210. https://doi.org/10.1097/IAE.0b013e31825bc0de
VanderBeek BL, Johnson MW (2012) The diversity of traction mechanisms in myopic traction maculopathy. Am J Ophthalmo 153:93–102. https://doi.org/10.1016/j.ajo.2011.06.016
Kobayashi H, Kishi S (2003) Vitreous surgery for highly myopic eyes with foveal detachment and retinoschisis. Ophthalmology 110:1702–1707. https://doi.org/10.1016/S0161-6420(03)00714-0
Yeh SI, Chang WC, Chen LJ (2008) Vitrectomy without internal limiting membrane peeling for macular retinoschisis and foveal detachment in highly myopic eyes. Acta Ophthalmol 86:219–224. https://doi.org/10.1111/j.1600-0420.2007.00974.x
Meng B, Zhao L, Yin Y, Li H, Wang X, Yang X, You R, Wang J, Zhang Y, Wang H, Du R, Wang N, Zhan S, Wang Y (2017) Internal limiting membrane peeling and gas tamponade for myopic foveoschisis: a systematic review and meta-analysis. BMC Ophthalmol 17:166. https://doi.org/10.1186/s12886-017-0562-8
Hattori K, Kataoka K, Takeuchi J, Ito Y, Terasaki H (2018) Predictive factors of surgical outcomes in vitrectomy for myopic traction maculopathy. Retina 38(Suppl 1):S23-30. https://doi.org/10.1097/IAE.0000000000001927
Gao X, Ikuno Y, Fujimoto S, Nishida K (2013) Risk factors for development of full-thickness macular holes after pars plana vitrectomy for myopic foveoschisis. Am J Ophthalmol 155:1021–1027. https://doi.org/10.1016/j.ajo.2013.01.023
Ikuno Y, Sayanagi K, Oshima T, Gomi F, Kusaka S, Kamei M, Ohji M, Fujikado T, Tano Y (2003) Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes. Am J Ophthalmol 136:477–481. https://doi.org/10.1016/s0002-9394(03)00269-1
Nakanishi H, Kuriyama S, Saito I, Okada M, Kita M, Kurimoto Y, Kimura H, Takagi H, Yoshimura N (2008) Prognostic factor analysis in pars plana vitrectomy for retinal detachment attributable to macular hole in high myopia: a multicenter study. Am J Ophthalmol 146:198–204. https://doi.org/10.1016/j.ajo.2008.04.022
Shimada N, Sugamoto Y, Ogawa M, Takase H, Ohno-Matsui K (2012) Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol 154:693–701. https://doi.org/10.1016/j.ajo.2012.04.013
Ho TC, Yang CM, Huang JS, Yang CH, Yeh PT, Chen TC, Ho A, Chen MS (2014) Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy. Retina 34:1833–1840. https://doi.org/10.1097/IAE.0000000000000149
Tian T, ** H, Zhang Q, Zhang X, Zhang H, Zhao P (2018) Long-term surgical outcomes of multiple parfoveolar curvilinear internal limiting membrane peeling for myopic foveoschisis. Eye (Lond) 32:1783–1789. https://doi.org/10.1038/s41433-018-0178-0
Elwan MM, Elghafar AEA, Hagras SM, Samra WAA, Saleh SM (2019) Long-term outcome of internal limiting membrane peeling with and without foveal sparing in myopic foveoschisis. Eur J Ophthalmol 29:69–74. https://doi.org/10.1177/1120672117750059
Wang L, Wang Y, Li Y, Yan Z, Li Y, Lu L, Lu T, Wang X, Zhang S, Shang Y (2019) Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis. Medicine (Baltimore) 98:e14710. https://doi.org/10.1097/MD.0000000000014710
Wu J, Xu Q, Luan J (2020) Vitrectomy with fovea-sparing ILM peeling versus total ILM peeling for myopic traction maculopathy: a meta-analysis. Eur J Ophthalmol 3:1120672120970111. https://doi.org/10.1177/1120672120970111
Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-z
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12. https://doi.org/10.1016/0197-2456(95)00134-4
Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826. https://doi.org/10.7326/0003-4819-127-9-199711010-00008
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101
Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634. https://doi.org/10.1136/bmj.315.7109.629
Itoh Y, Inoue M, Kato Y, Koto T, Hirakata A (2019) Alterations of foveal architecture during vitrectomy for myopic retinoschisis identified by intraoperative optical coherence tomography. Ophthalmologica 242:87–97. https://doi.org/10.1159/000500362
Iwasaki M, Miyamoto H, Okushiba U, Imaizumi H (2020) Fovea-sparing internal limiting membrane peeling versus complete internal limiting membrane peeling for myopic traction maculopathy. Jpn J Ophthalmo 64:13–21. https://doi.org/10.1007/s10384-019-00696-1
Zhu L, Chen X, Yan Y, Ding Q, Hu C, Huang Z (2020) Comparison of the efficacy of vitrectomy combined with complete internal limiting membrane peeling and fovea-sparing internal limiting membrane peeling for high myopia macular foveoschisis. Chin J Ocul Fundus Dis 36:509–513. https://doi.org/10.3760/cma.j.cn511434-20200102-00001
Shiraki N, Wakabayashi T, Ikuno Y, Matsumura N, Sato S, Sakaguchi H, Nishida K (2020) Fovea-sparing versus standard internal limiting membrane peeling for myopic traction maculopathy: a study of 102 consecutive cases. Ophthalmol Retina 4:1170–1180. https://doi.org/10.1016/j.oret.2020.05.016
Ying J, Li J, Xu GZ, Yu SP (2020) Therapeutic effects of pars plana vitrectomy combined with internal limiting membrane peeling on high myopic foveoschisis. Zhonghua Yan Ke Za Zhi 56:928–932. https://doi.org/10.3760/cma.j.cn112142-20200319-00204
VanderBeek BL, Johnson MW (2012) The diversity of traction mechanisms in myopic traction maculopathy. Am J Ophthalmol 153:93–102. https://doi.org/10.1016/j.ajo.2011.06.016
Ikuno Y, Sayanagi K, Ohji M, Kamei M, Gomi F, Harino S, Fujikado T, Tano Y (2004) Vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Am J Ophthalmol 137:719–724. https://doi.org/10.1016/j.ajo.2003.10.019
Gass JD (1999) Müller cell cone, an overlooked part of the anatomy of the fovea centralis: hypotheses concerning its role in the pathogenesis of macular hole and foveomacualr retinoschisis. Arch Ophthalmol 117:821–823. https://doi.org/10.1001/archopht.117.6.821
Yamada E (1969) Some structural features of the fovea centralis in the human retina. Arch Ophthalmol 82:151–159. https://doi.org/10.1001/archopht.1969.00990020153002
Lee CL, Wu WC, Chen KJ, Chiu LY, Wu KY, Chang YC (2017) Modified internal limiting membrane peeling technique (maculorrhexis) for myopic foveoschisis surgery. Acta Ophthalmol 95:e128–e131. https://doi.org/10.1111/aos.13115
**e ZG, He QY, Zhu J, Du W, Tong J, Chen F (2020) A modified surgical technique of fovea-sparing internal limiting membrane peeling: continuous arc-shaped foldback peeling. J Ophthalmol 2020:3568938. https://doi.org/10.1155/2020/3568938
Shin JY, Yu HG (2012) Visual prognosis and spectral-domain optical coherence tomography findings of myopic foveoschisis surgery using 25-gauge transconjunctival sutureless vitrectomy. Retina 32:486–492. https://doi.org/10.1097/IAE.0b013e31822058d1
Acknowledgements
We would like to thank Radouil Tzekov for his work as a voluntary copy editor of the manuscript.
Funding
Supported by the Science Research Foundation of Aier Eye Hospital Group (No.AM1901D3 and No.AR2001D1 to WS Li); Innovation Guidance Project of Science and Technology Department of Hunan Province (No.2018SK50102 to WS Li) and Welfare Technology Applied Research Program Fund of Science Technology Department of Zhejiang Province (No. LGF18H120002 to YH Tong).
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GHC, SHM, and WSL conceived and designed the study; acquisition of data was done by GHC, YHT, and FZJ; analysis and interpretation of data were done by GHC, SHM, and JSY; drafting the manuscript was done by GHC, SHM, and YHT; revising the manuscript critically for important intellectual content was done by WSL. All authors read and approved the final manuscript.
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Chen, G., Mao, S., Tong, Y. et al. Fovea sparing versus complete internal limiting membrane peeling for myopic traction maculopathy: a meta-analysis. Int Ophthalmol 42, 765–773 (2022). https://doi.org/10.1007/s10792-021-02042-2
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DOI: https://doi.org/10.1007/s10792-021-02042-2