| Epidemiology data shows that myopia has become increasingly serious health problems.Our country is myopia powers,myopia number more than 400 million,more than a 10 million high myopia.Myopic foveoschisis is one of the complications of high myopia which refers to the macular light-sensitive retina separation between the layers.In optical coherence tomography,it is characterized by a crack sample optical space,there are samples with vertical or oblique columnar band connection which eventually lead to thickening of neuroepithelium retina and before the retinal pigment epithelium there is thin moderate reflection.At present,the pathogenesis of myopic foveoschisis is not very clear,most researchers think that may be related to the traction of vitreous body,posterior staphyloma,the traction of retinal blood vessels,pole of the choroid retinal atrophy degeneration,hydration and so on.For the treatment of macular retinoschisis in highly myopic eyes,there is no exact and effective method up to now,some researchers attempted to undergo standard 3-port pars plana vitrectomy combined with internal limiting membrane peeling to treat this disease and had a certain curative effect.However for patients with posterior staphyloma after vitrectomy with internal limiting membrane peeling remove or reduce the traction of vitreous body and internal limiting membrane,but can’t stop caused by axial extension of the passive traction retinal choroid continued backward,Myopic foveoschisis progress factors still exist.Scleral shortening can shorten the ocular axial length and used for the treatment of high myopia and retinal detachment.However,it has not been found that the research of vitrectomy combined with internal limiting membrane peeling and scleral shortening surgery in the treatment of macular retinoschisis in highly myopic eyes.Objective: To survey the efficacy of vitrectomy with internal limiting membrane peelinng and scleral shortening for macular retinoschisis in highly myopic eyes,compare the changes of the ocular axial length and macular structure and function before and after the surgery.Methods: From February 2014 to December 2015,a total of 35 eyes of 35 highly myopic patients who were diagnosed as macular retinoschisis were collected.The cases were divided into 2 groups: 18 eyes received the treatment of vitrectomy with internal limiting membrane peeling and scleral shortening(the experimental group).17 eyes received the treatment of vitrectomy with internal limiting membrane peeling(the control group).In the experimental group,as pole of the choroid retinal atrophy degeneration and retinal thinning,there were three eyes of the internal limiting membrane which could not be identified and failed to peel,then underwent silicon oil tamponade.Half a year later,the eye underwent silicon oil removal surgery.Other patients underwent intraocular gas treatment,followed by prone posturing for 15 days at least.Before and after the surgery of the experimental group and control group,the best corrected visual acuity(BCVA)were obtained and compared by the paired t-test,while the ocular axial length,the maximum foveal thickness(MxFT)and the respond densities of wave b of multifocal electroretinogram(mfERG)were compared by the Wilcoxon signed-rank test.After the surgery of the experimental group and the control group,the BCVA were compared by the two-sample t-test,while the MxFT and the respond densities of wave b were compared by the Wilcoxon rank sum test.Results:1 Best Corrected Visual Acuity: Postoperative BCVA was better than the preoperative significantly in the experimental group(t=7.272,P=0.000 <0.01)and the BCVA of the control group was better than the preoperative(t=5.951,P=0.000<0.01).The postoperative of the experimental group BCVA was better than that in the control group(t=-2.280,P=0.029 <0.05).2 Ocular axial length: Postoperative ocular axial length was better than the preoperative significantly in the experimental group(t=10.017,P=0.000<0.01).3 Maximum Foveal Thickness: The MxFT was significantly decreased after surgery in the experimental group(Z=-3.724,P=0.000<0.01)and that of the control group was decreased compared with preoperative(Z=-3.622,P=0.000<0.01).The Mx FT of the experimental was markedly lower than that in the control group(Z=-4.179,P=0.000<0.01).4 mfERG: The postoperative respond densities of wave b was higher than the preoperative in the experimental group(Z=-3.223,P=0.001<0.01)and that of the control group was higher than the preoperative(Z=-3.243,P=0.001 <0.01).The postoperative respond densities of wave b of the experimental group and the control group had no statistical significance(Z=-0.198,P=0.843>0.05).5 Complications: In the experimental group and the control group,there are no iatrogenic retinal holes formed in the surgery and after surgery,no endoophthalmitis or hemorrhage happened.After surgery,one eye got retinal detachment in the experimental group,then underwent vitrectomy combined with silicon oil tamponade.Half a year later,the eye underwent silicon oil removal surgery,then the retina reattached.In the control group,one eye got a hole on the peripheral retinal,led to retinal detachment,then underwent vitrectomy combined with silicon oil tamponade.Half a year later,the eye underwent silicon oil removal surgery,then the retina reattached.Conclusion:Pars plana vitrectomy combined with internal limiting membrane peeling and scleral shortening for macular retinoschisis in highly myopic eyes,removes the traction of internal limiting membrane and vitreous body,shortens the ocular axial length significantly and makes the split retina into normal anatomical structure and improves the BCVA of the patients safely and effectively.Compared with Pars plana vitrectomy combined with internal limiting membrane peeling,vitrectomy with internal limiting membrane peeling and scleral shortening can shorten the ocular axial length significantly,improve the rate of the split retina into normal anatomical structure. |
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