Comparative Analysis On The Clinical Efficacy Of Three Surgical Methods For The Treatment Of Macular Foveoschisis In Highly Myopic Eyes

Objective:In this study,the therapeutic effects of vitrectomy plus gas filling and the combined surgery of vitrectomy+ internal limiting membrane peeling and the combined surgery of vitrectomy+internal limiting membrane peeling+gas filling were compared in the treatment of macular foveoschisis in high myopia.The best corrected visual acuity,maximum foveal thickness,axial length and the function of macula cells before and after intervention were evaluated to explore the operation scheme with the least damage and the best effect.Methods:A total of 17 patients(20 eyes)with high myopic macular foveoschisis were collected from November 2019 to November 2020,including 4 males(6 eyes)and 13 females(14 eyes).According to the actual clinical needs of the patient,the patients were divided into three groups:vitrectomy plus gas filling in group A(6 eyes),the combined surgery of vitrectomy+internal limiting membrane peeling+gas filling in group B(7 eyes),the combined surgery of vitrectomy+internal limiting membrane peeling in group C(7 eyes).The follow-up period ranged from 6 months to 9 months,with an average follow-up time of(7.8±1.5)months.The changes of best corrected visual acuity((best corrected visual acuity,BCVA),axial length(axial length,AL),the highest value of macular foveoschisis(maximum foveal thickness,MxFT),P1-wave amplitude of multifocal electroretinogram(multifocal electroretinogram,mfERG)and three-dimensional topographic map were compared between groups before and after operation.SPSS26.0 was used to analyze the data of each group.Results:1.There were no visible differences in age,diopter,best corrected visual acuity,axial length,P1 wave amplitude and the highest value of macular foveoschisis among the three groups(P>0.05).2.Six months after operation,the best corrected LogMAR visual acuity in the three groups was significantly higher than that before operation,and there was significant difference among the three groups(P<0.05).However,there was no significant difference in postoperative best corrected LogMAR visual acuity between group A and group B,and between group B and group C(P>0.05).There was significant difference in postoperative best corrected LogMAR visual acuity between group A and group C(P<0.05),indicating that vitrectomy plus gas filling was superior to vitrectomy combined with internal limiting membrane exfoliation in improving visual acuity to some extent.3.Six months after operation,the MxFT of the three groups decreased compared with that before operation,and there was statistically visible difference(P<0.05).No visible difference could be found in postoperative MxFT between group A and group B,group B and group C(P>0.05).There was significant difference in postoperative MxFT between group A and group B and group C(P<0.05),which indicated that the recovery of macular splitting after vitrectomy plus gas filling was better than that of the combined surgery of vitrectomy+internal limiting membrane peeling to some extent.4.Six months after operation,the eye axis length(AL)of the three groups was no significant change,and there was no significant difference among the three groups compared with that before operation(P>0.05).There was no significant difference in the postoperative axial length(AL)among the three groups(P>0.05).5.Six months after operation,the amplitude of P1 wave visibly changed to be higher than that before operation in the three groups(P<0.05).The preoperative mfERG showed that the central peak of the three dimensional topographic map was low,flat even disappear,and many irregular low response areas could be found in the adjacent fovea.The central peak of most patients after operation was gradually higher than that before operation,and the irregular low response area in the adjacent fovea became less or disappeared.There was no significant difference in postoperative P1-wave amplitude between the three groups(P>0.05).Conclusion:The three surgical methods are safe and effective for macular foveoschisis in high myopia,but each has its own advantages and disadvantages.To a certain extent,the three kinds of surgery can help patients improve visual acuity,reduce the height of cleavage cavity and improve macular function,but there was no significant effect on the axial length of patients.Vitrectomy plus gas filling is superior to vitrectomy combined with internal limiting membrane peeling in improving postoperative visual acuity and reducing the height of split cavity.Vitrectomy+gas filling and the combined surgery of vitrectomy+internal limiting membrane peeling+gas filling have higher requirements for patients,need a long time prone position rest,and poor vision for a period of time after operation due to the gas interference,which need to be fully understood by patients.The combined surgery of vitrectomy+internal limiting membrane peeling+gas filling and the combined surgery of vitrectomy+internal limiting membrane peeling cause structural changes of macular retina,which may lead to some related complications such as macular hole and retinal detachment.Clinicians should master the indications of various surgical methods,and fully communicate the complications of these surgical methods,the advantages and disadvantages with patients and their families when choosing surgical methods,according to the patient’s age,symptoms,the severity of the disease and the degree of cooperation of patients to choose appropriate surgical methods,in order to achieve the best treatment effect.