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A Modified Surgical Technique of Fovea-Sparing Internal Limiting Membrane Peeling: Continuous Arc-Shaped Foldback
Zheng-Gao Xie1,2, Qing-Yi He2, Jun Zhu2
1Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Purpose:
To investigate the efficacy of management of high myopic foveoschisis (MF) with a modified surgical technique of arc-shaped foldback fovea-sparing internal limiting membrane (ILM) peeling.
Methods:
A 23-gauge vitrectomy was performed in five patients with high MF. A long strip of ILM was peeled at the temporal side of the central fovea. Next, an ILM forceps was used to grasp the outer side of the ILM flap, and it was moved forward slowly from the outside to the paracentral fovea, followed by folding ILM back in an arc-shaped manner and then removing it. The above operations were repeated, and all ILM flaps were removed from the outside to paracentral fovea until a narrow strip of ILM remained. Finally, the narrow strip of ILM was excised using a vitreous cutter.
Results:
At the patients' last visits, the foveoschisis almost disappeared completely and the fovea reattached. The central macular thickness statistically decreased from 399.0 ± 96.33 μm preoperatively to 164.60 ± 34.20 μm postoperatively (t = 4.289; P=0.013). The preoperative mean logarithm of the minimum angle of resolution best-corrected visual acuity (1.64 ± 0.65) significantly improved to 0.72 ± 0.18 postoperatively (t = 3.265, P=0.031). The average follow-up time was 11.80 ± 3.35 months (range; 8-16 months).
Conclusion:
The arc-shaped foldback fovea-sparing ILM peeling technique for high MF is safe and effective.
Insights
This study shows a new surgical method for high myopic foveoschisis (MF) is safe and effective. The arc-shaped foldback fovea-sparing internal limiting membrane (ILM) peeling technique successfully treated MF, improving vision and reducing macular thickness.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Myopia Research
Background:
- High myopia can lead to complications like myopic foveoschisis (MF).
- Standard surgical techniques for MF may pose risks to the fovea.
- Fovea-sparing internal limiting membrane (ILM) peeling is a critical consideration in MF management.
Purpose of the Study:
- To evaluate the efficacy of a modified arc-shaped foldback fovea-sparing ILM peeling technique for treating high myopic foveoschisis (MF).
- To assess the safety and visual outcomes of this novel surgical approach.
Main Methods:
- A 23-gauge vitrectomy was performed on five patients diagnosed with high MF.
- A modified ILM peeling technique involved creating arc-shaped foldback flaps, sparing the fovea.
- ILM removal was systematically performed from the periphery towards the fovea, followed by final excision.
Main Results:
- Complete resolution of foveoschisis and successful foveal reattachment were observed in all patients.
- A statistically significant reduction in central macular thickness was noted postoperatively (399.0 ± 96.33 μm to 164.60 ± 34.20 μm).
- Best-corrected visual acuity significantly improved from a mean logarithm of the minimum angle of resolution of 1.64 ± 0.65 to 0.72 ± 0.18.
Conclusions:
- The arc-shaped foldback fovea-sparing ILM peeling technique is a safe and effective treatment for high myopic foveoschisis.
- This modified technique offers a promising surgical option for managing MF while preserving foveal integrity.
- The study demonstrates significant visual and anatomical improvements in patients undergoing this procedure.
