Internal limiting membrane peeling combined with silicone oil or air tamponade for highly myopic foveoschisis

AIM:To compare the efficacy of pars plana vitrectomy(PPV)combined with internal limiting membrane(ILM)and silicone oil or sterile air tamponade for the treatment of myopic foveoschisis(MF)in highly myopic eyes.METHODS:This retrospective study included 48 myopic eyes of 40 patients with MF and axial lengths(ALs)ranging from 26-32 mm treated between January 2020 and January 2022.All patients were underwent PPV combined with ILM peeling followed by sterile air or silicone oil tamponade and followed up at least 12mo.Based on the features on spectral-domain optical coherence tomography(SD-OCT),the eyes were divided into the MF-only group(Group A,n=15 eyes),MF with central foveal detachment group(Group B,n=20 eyes),and MF with lamellar macular hole group(Group C,n=13 eyes).According to AL,eyes were further divided into three groups:Group D(26.01-28.00 mm,n=12 eyes),Group E(28.01-30.00 mm,n=26 eyes),and Group F(30.01-32.00 mm,n=10 eyes).The best-corrected visual acuity(BCVA),central foveal thickness(CFT),and complications were recorded.RESULTS:The patients included 16 males and 24 females with the mean age of 56±9.82y.The BCVA and CFT improved in all groups after surgery(P<0.01),while there was no significant difference of the CFT in Group A,B,and C postoperatively(P>0.05).The intergroup differences of BCVA and CFT postoperatively were statistically significant in Group D,E,and F.Twenty eyes were injected with sterile air,and 28 eyes were injected with silicone oil for tamponade based on the AL.However,there was no statistically significant difference among Groups D,E,and F in terms of the results of sterile air or silicone oil tamponade.The mean recovery time was 5.9mo for MF patients subjected to silicone oil tamponade and 7.7mo for patients subjected to sterile air tamponade,and the difference was not statistically significant.CONCLUSION:PPV and ILM peeling combined with silicone oil or sterile air tamponade can achieve good results for MF in highly myopic eyes with ALs≤32 mm.

Using choroidal thickness to detect myopic macular degeneration

AIM:To explore the usage of choroidal thickness measured by swept-source optical coherence tomography(SS-OCT)to detect myopic macular degeneration(MMD)in high myopic participants.METHODS:Participants with bilateral high myopia(≤−6 diopters)were recruited from a subset of the Guangzhou Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study.SS-OCT was performed to determine the choroidal thickness,and myopic maculopathy was graded by the International Meta-Analysis for Pathologic Myopia(META-PM)Classification.Presence of MMD was defined as META-PM category 2 or above.RESULTS:A total of 568 right eyes were included for analysis.Eyes with MMD(n=106,18.7%)were found to have older age,longer axial lengths(AL),higher myopic spherical equivalents(SE),and reduced choroidal thickness in each Early Treatment Diabetic Retinopathy Study(ETDRS)grid sector(P<0.001).The area under the receiver operating characteristic(ROC)curves(AUC)for subfoveal choroidal thickness(0.907)was greater than that of the model,including age,AL,and SE at 0.6249,0.8208,and 0.8205,respectively.The choroidal thickness of the inner and outer nasal sectors was the most accurate indicator of MMD(AUC of 0.928 and 0.923,respectively).An outer nasal sector choroidal thickness of less than 74μm demonstrated the highest odds of predicting MMD(OR=33.8).CONCLUSION:Choroidal thickness detects the presence of MMD with high agreement,particularly of the inner and outer nasal sectors of the posterior pole,which appears to be a biometric parameter more precise than age,AL,or SE.

Resolving Myopic Foveoretinal Detachment by Fovea-Saving Internal Limiting Membrane Peeling: A Case-Series Report

Background: In highly myopic eyes, myopic foveoschisis (MF), the earliest stage of myopic traction maculopathy (MTM), is present in up to 34% of patients with pathologic myopia and slowly progresses to form foveoretinal detachment (FRD) or macular hole (MH) with or without macular hole retinal detachment (MHRD) as a part of its natural history. Aim: To describe the microstructural and functional results in three highly myopic eyes that underwent macular surgery for early-stage MTM. The last postoperative structural findings were correlated with the final vision and macular automated microperimetry evaluation. Methods: We retrospectively reviewed three highly myopic eyes that underwent successful fovea-saving internal limiting membrane (FS-ILM) macular surgery for chronic FRD at Oftalmologia Integral ABC, Mexico City, Mexico. We performed postoperative multimodal microstructural and functional evaluations, including SD-OCT, SS-OCT, and microperimetric macular examinations. Results: There was a substantial difference between best-corrected visual acuity (BCVA) preoperatively and postoperatively in all three cases. Postoperative surgery was associated with significant improvement in visual acuity confirmed using a paired-sample permutation test. The mean presurgical BCVA value (LogMAR;mean ± SE) was ~0.83 ± 0.15, and the postsurgical value was ~0.43 ± 0.52 (P = 0.00065). The myopic foveoretinal detachment evaluation was ~7.3 ± 3.5 months, with a mean postoperative follow-up time of ~14 ± 4.08 months. Furthermore, postoperative multimodal imaging tests demonstrated an abnormal microstructural foveal SS-OCT pattern without evidence of macular hole (MH) development at the postoperative follow-up. Macular microperimetry confirmed a subclinical reduced macula threshold sensitivity with an anomalous retinal sensitivity analysis map and a stable central foveal fixation site. Conclusions: Even with the successful microstructural disappearance of myopic macular detachment, the last multidisciplinary functional and structural assessments demonstrated different subclinical macular alterations.

Long-Term Postoperative Perfusion Indices in Surgically Resolved Myopic Traction Maculopathy

Background: Pathological myopia can be complicated by the presence of posterior staphyloma, macular atrophy, ruptures in Bruch’s membrane, pathologic choroidal neovascularization, and different degrees of myopic traction maculopathy. Purpose: To report the structural, functional and perfusional outcomes in patients underwent surgery for different stages of myopic traction maculopathy (MTM). Methods: A retrospective, consecutive, comparative, interventional, one-surgeon, case-control study was conducted in 46 eyes of 34 individuals between April 2015 and May 2021. Participants included normal emmetropic eyes (Control emmetropia, n = 25), healthy myopic eyes (Control high myopia, n = 20), and operated and structurally fully resolved myopic eyes with different stages of MTM (Surgically treated group, n = 46). Long-term postoperative functional and perfusional follow-up evaluations were performed with spectral domain-optical coherence tomography (SD-OCT) and OCT angiography. The primary outcome measure included long-term functional, structural and perfusion macular status across groups. Results: Forty-six eyes in 34 patients were included in the study group, with both eyes affected in 12 (26.3%) patients. The mean axial length was 29.89 ± 1.67 mm. The preoperative logMAR was 1.29 ± 0.54 and the postoperative logMAR was 0.60 ± 0.52 (P Conclusion: Compared to emmetropic and healthy myopic eyes, surgically-resolved MTM eyes generally have larger superficial foveal avascular zone area, lower vessel density, smaller choriocapillaris flow area, thinner central subfoveal thickness, and more macular defects. Eyes with stage III or IV MTM had larger deviation compared to eyes at earlier stages. Visual function change after surgery was associated with superficial foveal avascular zone area. Better functional, structural and perfusion index outcomes were observed when highly myopic eyes underwent early surgery.

Research on classification method of high myopic maculopathy based on retinal fundus images and optimized ALFA-Mix active learning algorithm

AIM:To conduct a classification study of high myopic maculopathy(HMM)using limited datasets,including tessellated fundus,diffuse chorioretinal atrophy,patchy chorioretinal atrophy,and macular atrophy,and minimize annotation costs,and to optimize the ALFA-Mix active learning algorithm and apply it to HMM classification.METHODS:The optimized ALFA-Mix algorithm(ALFAMix+)was compared with five algorithms,including ALFA-Mix.Four models,including Res Net18,were established.Each algorithm was combined with four models for experiments on the HMM dataset.Each experiment consisted of 20 active learning rounds,with 100 images selected per round.The algorithm was evaluated by comparing the number of rounds in which ALFA-Mix+outperformed other algorithms.Finally,this study employed six models,including Efficient Former,to classify HMM.The best-performing model among these models was selected as the baseline model and combined with the ALFA-Mix+algorithm to achieve satisfactor y classification results with a small dataset.RESULTS:ALFA-Mix+outperforms other algorithms with an average superiority of 16.6,14.75,16.8,and 16.7 rounds in terms of accuracy,sensitivity,specificity,and Kappa value,respectively.This study conducted experiments on classifying HMM using several advanced deep learning models with a complete training set of 4252 images.The Efficient Former achieved the best results with an accuracy,sensitivity,specificity,and Kappa value of 0.8821,0.8334,0.9693,and 0.8339,respectively.Therefore,by combining ALFA-Mix+with Efficient Former,this study achieved results with an accuracy,sensitivity,specificity,and Kappa value of 0.8964,0.8643,0.9721,and 0.8537,respectively.CONCLUSION:The ALFA-Mix+algorithm reduces the required samples without compromising accuracy.Compared to other algorithms,ALFA-Mix+outperforms in more rounds of experiments.It effectively selects valuable samples compared to other algorithms.In HMM classification,combining ALFA-Mix+with Efficient Former enhances model performance,further demonstrating the effectiveness of ALFA-Mix+.

Comparison of anatomical and functional outcomes of different surgical techniques in myopic macular hole without retinal detachment

AIM:To define the anatomic and functional outcomes of pars plana vitrectomy(PPV)with internal limiting membrane(ILM)peeling,inverted ILM flap and free ILM patch graft technique for the treatment of myopic macular hole(MH)without retinal detachment.METHODS:Sixty-four eyes of 64 patients who underwent PPV for myopic MH were included.Group 1 consists of patients underwent ILM peeling(n=26),and Groups 2 and 3 consists of patient underwent free ILM patch graft(n=20)and inverted ILM flap procedure(n=18)respectively.Outcomes following surgery were MH closure and best corrected visual acuity(BCVA)in logMAR at 6mo.RESULTS:Closure of MH was obtained in 20 eyes(76.9%)of the Group 1,in 16 eyes(80%)of the Group 2 and in 16 eyes(88.9%)of the Group 3.The mean preoperative and postoperative BCVA was 1.60±0.53 logMAR and 1.27±0.58 logMAR,respectively(P<0.05).There was no significant difference in the postoperative BCVA and anatomical closure rates in the three groups.Although the anatomical closure rate did not differ significantly in the groups,closure of MH tended to be better in the inverted ILM flap technique group at 6mo.CONCLUSION:Different surgical techniques may provide favorable visual and anatomical results for myopic MH surgery.ILM flap techniques offer higher closure rates compared to ILM peeling technique.However,in terms of visual outcomes,the study reveals no difference in three surgical techniques.

Different approaches for treating myopic choroidal neovascularization:a network Meta-analysis

AIM:To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor(anti-VEGF),photodynamic therapy(PDT),and laser treatment(LT)for anatomical and functional improvement in myopic choroidal neovascularization(mCNV)patients.METHODS:Two researchers independently searched PubMed,Cochrane Library,Web of Science,and other databases to screen studies comparing best-corrected vision acuity(BCVA)and foveal center thickness(FCT)changes after mCNV treatment.Post-treatment chorioretinal atrophy(CRA)is a secondary outcome indicator.The retrieval time limit is from the database construction to January 30,2023.RESULTS:A total of 1072 eyes in 16 articles were included.In the RCTs,intravitreal bevacizumab(IVB)and intravitreal ranibizumab(IVR)were superior to PDT(MD=0.18,95%CI:0.02,0.40,MD=0.18,95%CI:0.01,0.42)in improving BCVA of mCNV patients(P<0.05).The relative effectiveness in improving BCVA,from high to low,appeared to be IVR,intravitreal aflibercept(IVA),IVB,LT,PDT,and sham first followed by IVA(Sham/IVA).While improving the FCT from high to low was IVA,IVR,IVB,PDT.In retrospective studies,the results of BCVA after long-term treatment showed that all the therapeutic effects from high to low was IVA,intravitreal conbercept(IVC),IVR,IVB,IVB/IVR,PDT with IVB/IVR,PDT.The effect of improving FCT was IVA,IVR,IVC,PDT,and IVB from high to low.And in the effects of improving CRA,the IVB appeared to be higher than IVR,while the PDT was the smallest,but none of the differences in the results were statistically significant.CONCLUSION:Anti-VEGF has the best effect on longterm vision improvement in mCNV patients,using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT.There is no significant difference in the improvement of visual acuity,macular edema,and CRA in mCNV patients treated with any different anti-VEGF drugs.

A Semantic Adversarial Network for Detection and Classification of Myopic Maculopathy

The diagnosis of eye disease through deep learning (DL) technologyis the latest trend in the field of artificial intelligence (AI). Especially indiagnosing pathologic myopia (PM) lesions, the implementation of DL is adifficult task because of the classification complexity and definition system ofPM. However, it is possible to design an AI-based technique that can identifyPM automatically and help doctors make relevant decisions. To achieve thisobjective, it is important to have adequate resources such as a high-qualityPM image dataset and an expert team. The primary aim of this research isto design and train the DLs to automatically identify and classify PM intodifferent classes. In this article, we have developed a new class of DL models(SAN-FSL) for the segmentation and detection of PM through semanticadversarial networks (SAN) and few-short learning (FSL) methods, respectively.Compared to DL methods, the conventional segmentation methodsuse supervised learning models, so they (a) require a lot of data for trainingand (b) fixed weights are used after the completion of the training process.To solve such problems, the FSL technique was employed for model trainingwith few samples. The ability of FSL learning in UNet architectures is beingexplored, and to fine-tune the weights, a few new samples are being providedto the UNet. The outcomes show improvement in the detection area andclassification of PM stages. Betterment in the result is observed by sensitivity(SE) of 95%, specificity (SP) of 96%, and area under the receiver operatingcurve (AUC) of 98%, and the higher F1-score is achieved using 10-fold crossvalidation.Furthermore, the obtained results confirmed the superiority of theSAN-FSL method.

Peripapillary intrachoroidal cavitation at the crossroads of peripapillary myopic changes

AIM:To analyze the prevalence of peripapillary intrachoroidal cavitation(PICC)in eyes with gamma peripapillary atrophy(γPPA),in eyes with peripapillary staphyloma(PPS)and in those combiningγPPA and PPS and to analyze border tissue discontinuity in PICC.METHODS:This prospective cross-sectional non interventional study included highly myopic eyes.Non-highly myopic eyes were used as control.Radial and linear scans centered on the optic nerve head were performed using spectral-domain optical coherence tomography.Variables were analyzed along the twelve hourly optical coherence tomography sections in both eyes of each subject.RESULTS:A total of 667 eyes of 334 subjects were included:229(34.3%)highly myopic eyes and 438(65.7%)non highly myopic eyes.The mean age of the highly myopic group was 48.99±17.81y.PICC was found in a total of 40 eyes and in 13.2%(29/220)of highly myopic eyes.PICC was found in 10.4%(40/386)of eyes withγPPA,in 20.5%(40/195)of eyes with PPS and in 22.7%(40/176)of those combiningγPPA and PPS.All the eyes with PICC showed the co-existence ofγPPA and PPS whereas none of the eyes presenting only one of these entities exhibited PICC.A border tissue discontinuity in theγPPA area was found in all eyes with PICC.CONCLUSION:We confirm the presence of a border tissue discontinuity in theγPPA area of all eyes with PICC.These findings suggest the involvement of mechanical factors in the pathogenesis of PICC which may contribute to PICC-related visual field defects.

Visualized analysis of research on myopic traction maculopathy based on CiteSpace

AIM:To analyze the global scientific output concerning myopic traction maculopathy(MTM)and to summarize the research frontiers and hot topics of MTM related researches.METHODS:Data were collected for bibliometric and visualization analyses from Web of Science(WOS)Core Collection.Exported records were analyzed for titles,publication years,research institutions,journal names,authors,keywords,and abstracts using CiteSpace software version 6.1.RESULTS:A total of 839 related studies were analyzed,the publication volume increased annually,with Asia the most active region of MTM research.Optical coherence tomography angiography,optical coherence tomography,macular hole,high myopia,macular buckling were identified as the focus of the current research.Progression,association,classification and shape were identified as the major research frontiers.CONCLUSION:MTM is a major cause of visual loss in pathological myopic eyes.During the preceding 17y,the number of annual publications in MTM research increased gradually.Studies on the progression nature of MTM,genome-wide association study and proper classification of MTM might still be the frontiers of MTM researches.

Comparison of high order aberration after conventional and customized ablation in myopic LASIK in different eyes of the same patient

Purpose: To verify whether there exists any difference in higher order aberrations after undergoing myopic LASIK (laser in situ keratomileusis) with conventional ablation and customized ablation in different eyes of the same patient. Methods: This was a prospective randomized study of 54 myopic eyes (27 patients) that underwent LASIK using the Nidek EC-5000 ex-cimer laser system (Nidek, Gamagori, Japan). Topography-guided customized aspheric treatment zone (CATz) was used in the first eye of the patient (study group) and the other eye of the same patient was operated on with conventional ablation (control group). Higher order aberrations [root-mean-square (RMS) in the 5-mm zone] of both groups were observed with the Nidek OPD-Scan aberrometer before and 3 months after LASIK. Preoperative mean refractive error was similar between two eyes of the same patient (t=?0.577, P>0.05). Results: Preoperatively, higher order aberrations (RMS in the 5-mm zone) in the CATz ablation and conventional groups were (0.3600±0.0341) μm and (0.2680±0.1421) μm, respectively. This difference was not statistically significant (t=1.292, P>0.05). Three months after LASIK, higher order aberrations (RMS in 5-mm zone) in the CATz ablation and conventional groups were (0.3627±0.1510) μm and (0.3991±0.1582) μm, respectively. No statistically significant difference was noted between pre- and postoperative higher order aberrations in the CATz group (t=?0.047, P>0.05). However, a statistically significant increase in higher order aberrations was observed after conventional ablation (t=?5.261, P<0.05). A statistically sig-nificant difference was noted in the increase of higher order aberrations after LASIK between groups (t=?2.050, P=0.045). Con-clusion: LASIK with conventional ablation and topography-guided CATz ablation resulted in the same BSCVA (best specta-cle-corrected visual acuity) 3 month after LASIK. Higher order aberrations were increased, but the increase of higher order ab-errations after customized ablation treatment was less than that after conventional ablation.

Posterior scleral reinforcement combined with vitrectomy for myopic foveoschisis

AIM： To investigate the effects of posterior scleral reinforcement （PSR） combined with vitrectomy for myopic foveoschisis. ~ METHODS： Thirty-nine highly myopic eyes of 39 patients with myopic foveoschisis underwent PSR combined with vitrectomy. Best corrected visual acuity （BCVA）, refraction error, and the foveal thickness by optical coherence tomography （OCT） were recorded before and after the surgery, and complications were noted. RESULTS： The follow-up period was 12mo, and the main focus was on the results of the 12-month follow-up visit. The mean preoperative BCVA was 0.96±0.43 IogMAR. At the final follow-up visit, the mean BCVA was 0.46± 0.28 IogMAR, which significantly improved compared with the preoperative one （P =0.003）. The BCVA improved in 33 eyes （84.62%）, and unchanged in 6 eyes （15.38%）. At the end of follow-up, the mean refractive error was -15.13 ±2.55 D, and the improvement was significantly compared with the preoperative one （-17.53±4.51 D） （P= 0.002）. Twelve months after surgery, OCT showed complete resolution of the myopic foveoschisis and a reattachment of the fovea in 37 eyes （94.87%） and partial resolution in the remained two eyes （5.13%）. The foveal thickness was obviously reduced at 12-month follow-up visit （196.45±36.35um） compared with the preoperative one （389,32±75.56um） （P=0.002）. There were no serious complications during the 12mo follow-up period. CONCLUSION： PSR combined with vitrectomy is a safe and effective procedure for myopic foveoschisis with both visual and anatomic improvement.

Refractive errors in high myopic eyes after phacovitrectomy for macular hole

AIM: To examine the refractive prediction error in high myopic eyes after phacovitrectomy.METHODS: This retrospective comparative case series included 91 eyes(18 high myopic eyes and 73 non-high myopic eyes) of 91 patients who underwent successful phacovitrectomy(phacoemulsification, intraocular lens implantation, and pars plana vitrectomy). The high myopic eyes were defined as the eye with more than 26.0mm of axial length. The postoperative prediction error of mean error and mean absolute error were evaluated at4 mo postoperatively. Axial length and keratometry measurement were performed preoperatively and 4mo postoperatively using the IOL Master.RESULTS: The refractive outcome after phacovitrectomy showed significantly greater myopic shift in the high myopic eyes [-1.08 ±0.87 diopters(D)] than that in the non-high myopic eyes(-0.43 ±0.63 D, P =0.004). Axial length and keratometric value in the high myopic eyes were significantly increased(P =0.043, 0.037 respectively),whereas those in the non-high myopic group were not significantly increased(P =0.135, 0.347 respectively). The change of the axial length in the myopic eye(0.46±0.28 mm)was greater than that in the non- high myopic eye(0.11 ± 0.34 mm; P 【0.001).CONCLUSION: High myopic eyes showed more myopic shift than non-high myopic eyes after phacovitrectomy.The cause of myopic shift in high myopic eyes seems tobe attributed to actual elongation of the axial length in high myopia.

Diagnosis and treatment of myopic traction maculopathy

In recent years, the broad application of optical coherence tomography and vitrectomy, combined with research efforts in maculopathy in high myopia have provided many achievements, such as the new classification of myopic traction maculopathy (MTM). Here, we review the latest developments in the diagnosis and treatment of MTM, including its conception, clinical characteristics, pathogenesis, clinical stages, and the options for surgical treatment.

Long-term outcome of highly myopic foveoschisis treated by vitrectomy with or without gas tamponade

AIM：To evaluate the long-term safety and efficacy of vitrectomy and internal limiting membrane（ILM）peeling with or without gas tamponade for highly myopic foveoschisis.METHODS：We performed an open-label,observerblinded clinical trial of 85 patients with myopic foveoschisis between 2000 and 2012.Patients were randomly allocated to one of two groups,those who received vitrectomy and ILM peeling without gas tamponade（no-gas group）or those who with gas tamponade（gas group）and follow up at least 5y.RESULTS：Visual acuity of gas group improved from0.82±0.33 to 0.79±0.73 in 6mo,improved to 0.71±0.67 in 1y and within this range in the following 4y.Visual acuity of no-gas group improved from 0.81±0.46 to 0.78±0.66 in 6mo,improved to 0.70±0.65 in 1y.The finial visual acuity of two groups were significantly increased compared with the baseline（P〈0.05）.The visual acuity was improved in 35 of40 eyes（87.5%）in gas group and 29 of 33 eyes（87.9%）in no-gas group,while there were no significant differences between gas group and no-gas group in the visual acuity.The foveoschisis on optical coherence tomography（OCT）completely resolved in 5 of 40 eyes in 1mo,14 eyes in 6mo and 40 eyes in 1y in the gas group.While the foveoschisis completely resolved in 4 of 33 eyes in 1mo,10 eyes in 6mo and 33 eyes in 1y in the no-gas group.CONCLUSION：Vitrectomy and ILM peeling without gas tamponade appears to be as effective in the treatment of myopic foveoschisis as vitrectomy and ILM with gas tamponade.However,eyes treated with no-gas tamponade showed more rapid resolution of myopic foveoschisis.

Measurement of retinal thickness in macular region of high myopic eyes using spectral domain OCT

AIM: To investigate the changes of retinal thickness in macula of high myopic eyes using spectral domain optical coherence tomography(OCT). ·METHODS: Middle-aged and young myopic patients were divided into three groups according to their refractive error/axial length: low and medium myopia group(LMMG),high myopia group(HMG) and super high myopia group(SHMG). Cirrus HD-OCT was used to evaluate total average macular thickness,central subfield thickness,inner/outer macular thickness and macular volume. The differences among experimental groups were analyzed by one-factor analysis of variance. Associations between macular thickness and refractive error/axial length were analyzed by Pearson correlation analysis. ·RESULTS: There was no significant difference in age among the three groups(P =0.2789). The mean refraction error in the LMMG,HMG,and SHMG groups was-2.49 ± 1.38D,-8.53 ±1.95D and-13.88 ±1.76D,respectively(P 【 0.001). The central subfield thickness of three groups was 244.56 ±12.19μm,254.33 ±11.61μm and 261.75 ± 11.83μm,respectively,and there were statistically significance between random two groups. The total average macular thickness,inner/outer macular thickness,and macular volume decreased with increased myopia/axial length. Average foveal thickness had negative correlations with refractive error(P 【0.001),and positive correlations with axial length. The inferior and temporal inner macular thickness,all the quadrants of outer ring,total average macular thickness and macular volume featured positive correlations with refractive error,and negative correlations with axial length. Average foveal thickness,superior and temporal innermacular thicknesses,and temporal outer macular thickness was lower in females compared to males. ·CONCLUSION: With an increase in myopia degree/axial length,the average foveal thickness increased and the inner/outer macular thickness decreased. Females featured thicker average foveal thickness,and thinner macular thickness compared to males.

Long-term follow-up of vitrectomy in patients with pathologic myopic foveoschisis

AIM： To report the long-term surgical outcomes of pathologic myopic foveoschisis（MF） following vitrectomy.METHODS： We performed a retrospective case series analysis of 50 consecutive patients diagnosed with MF who experienced vision loss due to progression of foveoschisis.The 50 patients（67 eyes） were treated in our hospital with vitrectomy with internal limiting membrane（ILM） peeling from December 2004 to September 2010.Best corrected visual acuity（BCVA）,refractive error,optical coherence tomography（OCT）,and routine examination results were analysed.The changes of BCVA,foveal anatomical features on OCT scan,and complications were the main outcome measures.RESULTS： The mean follow-up duration was 42±17mo（range 24 to 93mo）.BCVA improved significantly postoperatively（0.76±0.65 logM AR） compared with preoperative baselines（1.31±0.78 log MAR,P〈0.0001）,and in 53 eyes（79%） including 3 lines gain in 44 eyes（66%） at the last follow-up visit.OCT scans showed that central retinal thickness decreased from 580.0±270.0 μm preoperatively（n=67） to 179.7±84.7 μm postoperatively（n=58,P〈0.0001）.Total resolution of foveoschisis occurred in 41 eyes（61%）.Preoperative BCVA correlated well with postoperative BCVA,whereas other factors such as age,axial length,and refractive error were not correlated.The most common complications were cataract and full-thickness macular hole formation in 14 and 9 cases,respectively.CONCLUSION： Patients with progressive vision loss due to MF who were treated with vitrectomy with ILM peelingshow favourable outcomes.In most eyes,visual acuity and foveal structure remain stable during long-term observation.

Corneal endothelial cell density and morphology in low and moderate myopic Chinese eyes

AIM:To describe and compare the corneal endothelial cell density and morphology in young,low and moderate myopic Chinese adults in Malaysian Chinese population.·METHODS:Non-contact specular microscopy(Topcon SP3000P,Tokyo,Japan) was performed in low(n =78;21.22±1.51 years) and moderate(n =78;21.82±1.40 years)myopic subjects.The mean of three consecutive measurements of endothelial cell density(MCD),coefficient of variation(CV) in the cell size,and hexagonal appearance of the cell were obtained.·RESULTS:In low myopic eyes the MCD was 3 063.0±176.2/mm2,the mean CV was 33.4 ±4.0% and the mean hexagonal appearance of the cell was 57.9 ±2.7%.In moderate myopic eyes the MCD was 2961.6 ±159.0/mm2,the mean CV was 33.9 ±3.6% and mean hexagonal appearance of the cell was 56.2 ±4.7%.There were statistically significant differences in MCD(P 【0.000) and hexagonal appearance of the cell(P 【0.005) between low and moderate myopic eyes.·CONCLUSION:The corneal endothelial cell layer in more myopic eyes tends to have less MCD and cell hexagonality compared to lower myopic eyes.Nevertheless,there is no significant difference in CV between low and moderate myopic eyes.

Phakic posterior chamber intraocular lens for unilateral high myopic amblyopia in Chinese pediatric patients

AIM： To assess the outcomes of posterior chamber implantable collamer lens （ICL） implantation in Chinese pediatric patients with unilateral high myopic amblyopia.METHODS： Eleven eyes of 11 amblyopic patients aged 11.02±3.34y underwent ICL （model V4, Staar Surgical Inc.） implantation to treat unilateral anisometropia were studied. Visual acuity, cycloplegic refraction, contrast sensitivity, stereopsis, intraocular pressure （IOP）, vaulting, corneal endothelial cell count and complications were evaluated. Patients completed follow-up at 3d, 1, 3mo and the last follow-up time （mean 8.18±2.82mo） after surgery.RESULTS： The mean myopic anisometropia was -13.70±3.25 D preoperatively and ＋0.69±2.63 D at 8mo postoperatively. The logMAR corrected distance visual acuity （CDVA） of the amblyopic eye was 1.51±0.72 preoperatively and 0.75±0.40 at 8mo postoperatively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by a mean of 0.64, 1.55, 1.82 and 2.64 lines and gained more than 2 lines accounted for 18%, 45%, 45%, 64%, respectively. The contrast sensitivity of 0.5, 1 and 2 cpd in amblyopic eyes was significantly increased after surgery. No patient had near stereopsis recovery. The vaulting at 3 and 8mo was significantly lower than that at 1mo postoperatively. No other intraoperative or postoperative complications were observed, except an acute pupillary block glaucoma happened in a patient at two weeks postoperatively.CONCLUSION： This short-term results indicate that ICL implantation can be a promising alternative therapy for high myopic anisometropic amblyopia in pediatric patients who have failed with conventional treatments and not suitable to corneal refraction surgery.

Measurements of the parapapillary atrophy area and other fundus morphological features in high myopia with or without posterior staphyloma and myopic traction maculopathy

AIM:To investigate the affecting factors of parapapillary gamma and delta zones and other fundus morphological features in high myopia.METHODS:Seventy high myopia patients were included in this retrospective observational study and 47 patients were female.Patients were divided into three groups:no posterior staphyloma(no PS),PS with myopic traction maculopathy(PS with MTM),and PS without MTM using 3-dimensional magnetic resonance imaging and optical coherence tomography.MTM patients were fur ther classified into three types[epiretinal membrane,macular hole,and macular retinoschisis(MRS)].Diameters of the gamma and delta zones were measured among other morphometric variables using fundus photographs.RESULTS:Of the 70 individuals(127 eyes),the mean age was 57.46±13.56y.In univariate analysis,morphological features changed most dramatically in PS with MTM patients,who had the largest gamma zone diameters,the largest disk-fovea distance(DFD)and disk-fovea angle,and the smallest angle kappa and vertical distance of temporal arterial arcade.However,their horizontal delta zone diameter was smaller than in the patients with PS yet without MTM.In multivariate analysis,with axial length(AL)and age adjusted,the horizontal diameter in the delta zone of the PS without MTM group was still significantly larger than in the PS with MTM group(P=0.024).Comparing the three subtypes of MTM patients,the diameters of the gamma zone and DFD in MRS group were the largest.CONCLUSION:The characteristics of the gamma and delta zones change inconsistently in different stages of high myopia.These changes may be associated with anatomical changes caused by local traction.Factors such as PS,AL and age play an important role.These findings may provide a hint about the pathogenesis of traction in high myopia.