Comparative Efficacy Analysis In The Treatment Of Pathological Myopic Macular Foveoschisis With Three Different Surgical Methods

Objective:The aim of this study was to compare the anatomical improvement and visual acuity benefits of pars plana vitrectomy(PPV)combined with three different treatments of the internal limiting membrane(ILM)in the treatment of pathological myopic macular schisis(PMF).Methods:A retrospective cohort study was performed on 28 PMF patients(33 eyes)who were treated with PPV at the Eye Hospital of Nanchang University from January to August 2021 and were followed up on time.According to different treatment methods of ILM during surgery,33 eyes were divided into non-exfoliation group(group A),complete macular ILM exfoliation group(group B),and circumfoveal ILM exfoliation group(group C).For 10,11,12 eyes.There were no significant differences in preoperative gender composition,age,axial length(AL),Equivalent spherical lens,best-corrected visual acuity(BCVA),intraocular pressure(IOP),and foveal retinoschisis(CFT)among the three groups of patients(c2=4.505,F=0.205,0.482,1.225,0.415,0.785,2.299,P>0.05).BCVA and CFT were measured repeatedly at 1 month,3 months,and 6 months after surgery.The visual acuity benefits,macular structure improvement,retinal reattachment rate and postoperative complications were observed in the three groups at the last follow-up,and the differences in the curative effects of different ILM treatments were compared.Results:1.At the last follow-up,the average BCVA(Log MAR)of patients in groups A,B,and C were all significantly improved compared with those before operation(P<0.001).There was no significant difference in the mean BCVA between the three groups and within the three groups at different follow-up time points after surgery(all comparisons were P>0.05).The changes in BCVA and preoperative BCVA(ΔBCVA)between the three groups at different follow-up time points were statistically different within the group(P<0.05 for all comparisons),but there was no significant difference between the groups(P>0.05 for all comparisons).2.At the last follow-up,the median(um)of CFT in groups A,B,and C was significantly improved compared with that before operation(P<0.001).There was no statistical significance in the comparison of CFT among the three groups at different follow-up time points after operation(all comparisons were P>0.05).3.Comparison of retinal reattachment among the three groups A,B,and C at the last follow-up: in group A,the complete reposition rate of the split cavity was 60%(6eyes),the partial reposition rate was 40%(4 eyes),and the non-reposition rate was0%(0 eyes);in group B,the complete reduction rate of the split cavity was 72.7%(8eyes),the partial reduction rate was 18.2%(2 eyes),and the non-reduction rate was9.1%(1 eye).66.7%(8 eyes),the partial reduction rate was 25%(3 eyes),and the non-reduction rate was 0.83%(1 eye).At the last follow-up,there was no statistical difference in retinal reattachment rate between groups(p>0.05).4.One eye in both group B and group C developed full-thickness macular hole(FTMH),the split cavity was not reset,and there were no other serious complications such as vitreous hemorrhage and retinal detachment.There was no statistical significance in postoperative complications among the three groups(P>0.05).5.A total of 5 cases(6 eyes)developed transient intraocular hypertension within1 month after operation,and the intraocular pressure became stable after the addition of IOP treatment.There was no significant difference in intraocular pressure between the three groups before and after surgery(P>0.05).6.Correlation analysis between each influencing factor and BCVA at last followup showed that BCVA at last follow-up was linear correlated with preoperative BCVA,but not with axial length,age and preoperative CFT.Conclusion:1.Vitrectomy can effectively improve the anatomical structure and visual acuity of PMF eyes with or without internal limiting membrane peeling.2.Vitrectomy without ILM peeling is equivalent to ILM peeling in terms of visual acuity and structural benefits,and does not increase the incidence of postoperative complications.It is a safe and effective operation for the treatment of PMF.