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.

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+.

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.

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.

A novel surgical technique of internal limiting membrane peeling for high myopic foveoschisis:a wide range of whole piece consecutive peeling without preservation of epi-fovea

AIM:To demonstrate an improved surgical technique of whole piece consecutive internal limiting membrane(ILM) peeling without preservation of the epi-fovea to treat high myopic foveoschisis(MF).METHODS:A 23-gauge 3-port pars plana vitrectomy was performed on 16 patients with high MF.A parallel arc line along the vascular arcades was scraped out with a curved membrane scraper DSP.Next,an ILM forceps was used to catch hold of the incisal edge of the ILM flap,and the action of releasing and separating was subsequently taken toward the direction of the macular fovea.Next,the ILM forceps was used to grasp the released area,and the whole area coherent ILM peeling covering the macular fovea was implemented thereafter.Finally,the ILM was folded backwards and peeled off in the arc direction.RESULTS:At the final visit,the average central macular thickness decreased remarkably from 423.76±177.67 to 178.24±66.21 μm.The mean logarithm of the minimum angle of resolution best-corrected visual acuity of 1.37±0.59 was significantly alleviated to 0.74±0.59.CONCLUSION:The wide range of whole piece consecutive ILM peeling without preservation of the epifovea is proven to be effective and significantly reduced the occurrence of retinal tear and macular hole.