OSLI Retina

October 2020

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574 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ E X P E R I M E N T A L S C I E N C E ■ Morphological Characteristics Predict Postoperative Outcomes After Vitrectomy in Myopic Traction Maculopathy Patients *Tian-Qi Duan, MD; *Wei Tan, MD; Jie Yang, MD; Fang-Ling Li, MD; Si-Qi Xiong, MD; Xiang-Gui Wang, MD; Hui-Zhuo Xu, MD BACKGROUND AND OBJECTIVES: To provide the sur- gical indication for patients with myopic traction maculopathy (MTM) by investigating the postop- erative outcomes after vitrectomy among different types of morphological characteristic groups. PATIENTS AND METHODS: This was a retrospective cohort study that included patients (37 eyes) diag- nosed with MTM at a single institution. All 37 eyes from 37 patients with MTMs were classified into three groups: foveal retinoschisis (FS), lamellar macular hole (LMH), and foveal retinal detachment (FRD). The ratios of anatomic recovery, central reti- nal thickness (CRT), and best-corrected visual acu- ity (BCVA) were statistically analyzed among the three groups preoperatively and at 1, 3, 6, and 12 months after vitrectomy. RESULTS: Anatomical recovery could be found in all patients of the FS group at 6 months post- operatively and in the LMH group at 12 months postoperatively. Only 83.33% patients in the FRD group showed anatomic recovery until 12 months. The time taken for CRT to reduce to 200 µm was gradually increased between the FS, LMH, and FRD groups. Postoperative BCVA was better in the FS group than the LMH and FRD groups (P < .05), but the LMH and FDR groups had no difference (P ≥ .05) at any point. The visual acuity was signifi- cantly improved in the FS group (P < .01) and FRD group (P = .018), but not in the LMH group (P = .196) at 12 months postoperatively. CONCLUSIONS: The FS group achieved anatomical recovery in the shortest time and had the best post- operative BCVA. FRD patients could get visual gain but need too much time for the anatomical recov- ery. LMH patients experienced anatomic success with surgery, but not in BCVA. Early surgery might be considered for eyes at FS prior to the occurrence of LMH or FRD. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:574-582.] INTRODUCTION Myopic traction maculopathy (MTM) is one of the major causes of poor vision in eyes with pathological macular lesions associated with high myopia, which are caused by traction and are discovered in 9% to 34% of high myopia and posterior staphylomas. 1-4 The vision suffers damage when MTMs present mani- festation including thickening of the retina, macular retinoschisis-like structures, foveal retinal detach- ment (FRD), and macular holes (MHs). There are many factors may affect the development of MTM, 2,5,6 but the pathogenesis is not clear. Post-vitreous de- tachment (PVD) is more likely to occur in patients with high myopia than in normal persons due to pos- terior scleral expansion, increased volume of vitreous cavity, and early vitreous degeneration and liquefac- tion. In the early stage of PVD, part of the posterior vitreous is still adhered to the macular fovea and reti- nal blood vessels, causing mechanical traction on the retina and consequently damaging the retina in the process of eye movement. 7,8 In addition, the dilated posterior sclera of high myopia stretches the retina, resulting in retinal thinning. The photoreceptor cell outer layer is closely connected with the retinal pig- ment epithelium (RPE) layer, resulting in the radial extension of the outer layer of the retina. Therefore, From Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China; and Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China. Originally submitted March 4, 2020. Revision received May 27, 2020. Accepted for publication July 9, 2020. Paper was previously published as a "preprint" article on Research Square: Duan TQ, Song K, Yang J, Li FL, Xiong SQ, Wang XG, Xu HZ. Morphological characteristics predict postoperative outcomes after vitrectomy in myopic traction maculopathy patients. Preprint. Posted online September 24, 2019. Research Square. doi:10.21203/rs.2.14742/v1 Supported by the Natural Science Foundation General Program of Hunan Province (2019JJ40528). The authors report no relevant financial disclosures. Drs. Duan and Tan contributed equally to this manuscript as co-first authors. Address correspondence to Hui-Zhuo Xu, MD, Eye Center of Xiangya Hospital, Central South University, No. 87, Xiangya Road, Kaifu District, Changsha 410008, Hunan Province, China; email: xhz1030@csu.edu.cn. doi: 10.3928/23258160-20201005-05

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