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Published on: June 27, 2025
A technique of TA-assisted ILM peeling for myopic foveoschisis
Liyan Ye1,2, Luyun Liang1,2, Xiaolan Liu1,2
1JiNan University, No. 601, West Huangpu Avenue, Tianhe District, Guangzhou City, Guangdong Province, 510632, China.
Objective:
To evaluate the clinical effects of using Triamcinolone Acetonide (TA) in fovea-sparing internal limiting membrane peeling (FILMP) technique for treating myopic foveoschisis (MF).
Methods:
This prospective study recruited 66 (72 eyes) non-consecutive patients diagnosed with MF from June 2018 to November 2020. All patients underwent FILMP combined with 25G pars plana vitrectomy (PPV). Based on the staining agents used during FILMP, patients were divided into the TA group and the indocyanine green (ICG) group. Preoperative and follow-up assessments included visual acuity, best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp examination of the anterior and posterior segments, optical coherence tomography (OCT), ultra-widefield fundus photography, and B-scan ultrasonography. Postoperative visual acuity, central retinal thickness (CRT), postoperative recovery of MF, and the incidence of postoperative full-thickness macular hole (MH) were compared between the two groups.
Results:
The mean age of patients was 56.16 ± 11.00 years (19 males and 47 females); the mean axial length was 30.50 ± 1.96 mm and the mean follow-up duration was 13.89 ± 8.32 months. Six patients underwent binocular surgery due to bilateral MF, while the remaining 60 patients underwent monocular surgery. Forty-four eyes received TA-assisted FILMP, and the remaining 28 eyes received ICG-assisted FILMP. A total of 65 patients, accounting for 90.3% (26 patients in the ICG group and 39 patients in the TA group), were treated with a 20% C3F8 tamponade. 40 patients, accounting for 69.4% (23 patients in the ICG group and 27 patients in the TA group), received combined 20% C3F8 tamponade and Phaco + IOL implantation. The total incidence of the postoperative full-thickness MH with FILMP was 4.9%. The mean postoperative logMAR visual acuity significantly improved compared to preoperative values (1.00 ± 0.62 vs. 1.67 ± 0.67, p < 0.01). Postoperative CRT was significantly thinner than the preoperative CRT (295.88 ± 167.55 μm vs 473.47 ± 195.96 μm, p < 0.01). There were no significant differences between the TA and ICG groups in the postoperative incidence of full-thickness MH, logMAR visual acuity, CRT, or MF recovery.
Conclusion:
Due to the strong adhesion of the posterior cortical vitreous, the internal limiting membrane (ILM) is difficult to stain with ICG. In contrast, TA can adhere well to the vitreous cortex and remain on the macular surface in eyes with MF. TA-assisted FILMP is a feasible approach for ILM peeling in MF. Large-sample, prospective and randomized controlled trials are needed to confirm these findings.
Trial Registration:
Chinese Clinical Trial Registry, ChiCTR2200060265, 2022-05-24, Retrospectively registered.
Insights
Triamcinolone Acetonide (TA) is a viable option for internal limiting membrane peeling in myopic foveoschisis (MF) surgery. This technique showed comparable outcomes to indocyanine green (ICG) in improving visual acuity and reducing retinal thickness.
Area of Science:
- Ophthalmology
- Retinal Surgery
Background:
- Myopic foveoschisis (MF) is a condition affecting the macula in highly myopic eyes.
- Internal limiting membrane (ILM) peeling is a key surgical step in treating MF.
- Traditional ILM staining agents like indocyanine green (ICG) can be challenging due to posterior vitreous adhesion.
Purpose of the Study:
- To evaluate the clinical efficacy of Triamcinolone Acetonide (TA) versus ICG in fovea-sparing internal limiting membrane peeling (FILMP) for MF.
- To compare postoperative outcomes, including visual acuity, retinal thickness, and complications, between TA-assisted and ICG-assisted FILMP.
Main Methods:
- A prospective study involving 66 patients (72 eyes) with MF undergoing 25-gauge pars plana vitrectomy (PPV) with FILMP.
- Patients were divided into two groups based on the ILM staining agent: TA group and ICG group.
- Preoperative and postoperative assessments included visual acuity, optical coherence tomography (OCT), and fundus photography.
Main Results:
- Both TA-assisted and ICG-assisted FILMP significantly improved visual acuity and reduced central retinal thickness (CRT) postoperatively.
- The incidence of postoperative full-thickness macular hole (MH) was low (4.9%) and similar between groups.
- No significant differences were observed between the TA and ICG groups regarding MH incidence, visual acuity, CRT, or MF recovery.
Conclusions:
- Triamcinolone Acetonide (TA) is a feasible and effective agent for ILM peeling in MF surgery, adhering well to the vitreous cortex.
- TA-assisted FILMP offers comparable clinical outcomes to ICG-assisted FILMP in treating myopic foveoschisis.
- Further large-scale, randomized controlled trials are recommended to validate these findings.
