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Ring-Peeling: A Novel Fovea-Sparing Internal Limiting Membrane Peeling Technique for Myopic Foveoschisis With Foveal
Jiao Lyu1, Dian Jiao, Peiquan Zhao
1Department of Ophthalmology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China .
Purpose:
To introduce a novel fovea-sparing internal limiting membrane (ILM) "Ring-peeling" technique and evaluate its effectiveness for treating myopic foveoschisis with foveal detachment through pars plana vitrectomy.
Methods:
This technique was applied to 12 eyes (11 patients). During pars plana vitrectomy, a 1-disc diameter-wide ILM flap was created, with its inner edge at least ¼ disc diameter from the foveola. The flap was peeled tangentially toward the fovea and parallel to the inner retinal curvature. When the flap narrowed to half its original width, it was centrifugally extended. Intraoperative ILM peeling performance, postoperative anatomical, and visual outcomes were measured.
Results:
During pars plana vitrectomy, an ILM shield was preserved on the fovea in all eyes. In 10 eyes (83.3%), ILM peeling was continuous and based on a single ILM flap. After a follow-up of 20.2 ± 7.1 months, schisis cavities resolved and the fovea reattached in all eyes. The external limiting membrane was retrieved in nine eyes (75%). Best-corrected visual acuity improved in all eyes compared to preoperative levels, with three eyes achieving a best-corrected visual acuity above 20/50.
Conclusion:
This technique enhances the certainty of preserving an ILM shield on the fovea and achieves good postoperative visual and anatomical outcomes.
Insights
A new "Ring-peeling" technique for internal limiting membrane (ILM) removal effectively treats myopic foveoschisis (MFS) with foveal detachment, preserving the fovea and improving vision.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Surgical Techniques
Background:
- Myopic foveoschisis (MFS) with foveal detachment presents surgical challenges.
- Effective internal limiting membrane (ILM) peeling is crucial for successful outcomes.
Purpose of the Study:
- To introduce a novel fovea-sparing ILM "Ring-peeling" technique.
- To evaluate the effectiveness of this technique in treating MFS with foveal detachment.
Main Methods:
- Pars plana vitrectomy (PPV) with a specialized ILM peeling technique.
- Creation of a 1-disc diameter (DD)-wide ILM flap, peeled tangentially.
- Assessment of intraoperative performance and postoperative outcomes.
Main Results:
- Fovea-sparing ILM shield preserved in all 12 eyes.
- Successful ILM peeling in 83.3% of eyes.
- Complete resolution of schisis cavities and foveal reattachment in all eyes.
- Improved best-corrected visual acuity (BCVA) in all eyes.
Conclusions:
- The "Ring-peeling" technique reliably preserves a foveal ILM shield.
- This method leads to favorable anatomical and visual recovery in MFS patients.
