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      Spontaneous resolution of foveal detachment in traction maculopathy in high myopia unrelated to posterior vitreous detachment

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          Abstract

          Background

          Foveal detachment associated with foveoschisis usually takes a progressive course, and is associated with a poor visual outcome. The purpose of this study was to report the spontaneous resolution of foveal detachment in patients with myopic traction maculopathy without posterior vitreous detachment.

          Methods

          A retrospective study involving eight cases of high myopia with foveoschisis and foveal detachment in which the subfoveal fluid had spontaneously resolved. The clinical characteristics and optical coherence tomography (OCT) findings were described.

          Results

          All cases involved predominant schisis in the outer retina, with six showing internal limiting membrane detachment. The average central foveal thickness was 445.1 μm, and the average foveal detachment height was 271.5 μm. None of the cases involved traction of the vitreomacular interface or posterior vitreous detachment (PVD), either before or after the resolution of foveal detachment. In seven cases, the mean best-corrected visual acuity improved after foveal reattachment.

          Conclusions

          Spontaneous reattachment not associated with PVD can occur in cases of high myopic traction maculopathy, especially in those without obvious vitreomacular traction.

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          Most cited references13

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          Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome.

          To determine the natural evolution and surgical indications of myopic foveoschisis (MF), which are still poorly documented, and the factors that predict poor prognosis. Retrospective observational case series. Twenty-nine operated and nonoperated cases of MF (29 eyes of 23 patients) were studied. All eyes underwent repeated examinations, including optical coherence tomographic (OCT) recordings, during a mean follow-up of 31.2 months. Special attention was paid to the evolution of visual acuity (VA) and to the thickness of foveoschisis. Mean refraction was -14.4 diopters, and mean axial length was 29.1 mm. OCT scans revealed that the foveoschisis was associated with macular anomalies: a premacular structure in 13 (44.8%) of 29 eyes, a foveal detachment in 10 (34.5%) of 29 eyes, and a lamellar macular hole in six (20.7%) of 29 eyes. Isolated foveoschisis was found in four eyes (13.8%). During follow-up, foveoschisis and VA worsened in 20 eyes and remained stable in nine. Ten of the 20 eyes that worsened had a premacular structure. A macular hole occurred in nine eyes, six of which had previously exhibited foveal detachment. Eleven eyes with foveoschisis underwent surgery, which improved VA significantly (P = .04, Wilcoxon test), but three eyes developed a macular hole. MF may remain stable for many years without affecting VA. However, when it is combined with the presence of a premacular structure, the risk of a decrease in VA increases. When it is combined with foveal detachment, a macular hole seems to develop frequently, whether or not surgery is performed.
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            Natural course of myopic traction maculopathy and factors associated with progression or resolution.

            To investigate the natural course of myopic traction maculopathy and to identify the factors associated with its progression or resolution in 207 highly myopic eyes. Retrospective, consecutive case series. We investigated 207 highly myopic eyes with myopic traction maculopathy by optical coherence tomography (OCT) and followed the patients for at least 24 months. The size of the macular retinoschisis was categorized according to its extent and location relative to the fovea. The clinical data, status of the myopic traction maculopathy, and changes in the posterior vitreous and inner limiting membrane (ILM) were analyzed during the natural course of the disease process. During a mean follow-up of 36.2 ± 6.2 months, 8 of 207 eyes (3.9%) showed a decrease or complete resolution of the macular retinoschisis. Of these 8 eyes, 6 had release of retinal traction in the OCT images, and 4 of the 6 eyes developed posterior vitreous detachment. A spontaneous disruption of the ILM occurred in 2 eyes before the improvement of the myopic traction maculopathy. Of the 207 eyes, 24 (11.6%) experienced progression of the myopic traction maculopathy. The eyes with more extensive macular retinoschisis showed progression significantly more commonly (42.9%) than the eyes having less extensive macular retinoschisis areas (6.7%). The natural course of myopic traction maculopathy varies, and eyes with more extensive macular retinoschisis tend to progress more commonly. A complete resolution of macular retinoschisis can occur after a release of traction on the retina. These findings can be used to determine whether surgery should be performed. Copyright © 2013 Elsevier Inc. All rights reserved.
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              Factors associated with foveoschisis and foveal detachment without macular hole in high myopia.

              To investigate the associated factors of foveoschisis and foveal detachment without macular hole in highly myopic eyes. A cross-sectional study of 124 eyes of 68 highly myopic patients was performed. The patients underwent complete ocular examination, fundus photography, and optical coherence tomography (OCT). Of the 124 eyes, 10 (8%, 10/124) had foveoschisis or foveal detachment without a macular hole on OCT examination. On the basis of univariate analysis, six variables were associated with the pathologic changes, including age over 40 years (P=0.018), spherical equivalent over 10 D (P=0.042), axial length over 31 mm (P=0.001), macular chorioretinal atrophy (P=0.00003), posterior staphyloma (P=0.0003), and vitreoretinal interface factors, including epiretinal membrane, posterior vitreoschisis, and vitreomacular traction (P=0.00002). In the multivariate analysis, three factors were independently associated with foveoschisis and foveal detachment without macular hole in high myopia: axial length, macular chorioretinal atrophy, and vitreoretinal interface factors. Foveoschisis and foveal detachment without macular hole are sight-threatening disorders in highly myopic eyes. Axial length, macular chorioretinal atrophy, and vitreoretinal interface factors were independently associated with these pathological conditions. Thus, both intraocular and outer ocular wall factors play important roles and merit further study.
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                Author and article information

                Contributors
                b91401005@ntu.edu.tw
                hotchang@ntu.edu.tw
                886-2-2356-5187 , chungmay@ntu.edu.tw
                Journal
                BMC Ophthalmol
                BMC Ophthalmol
                BMC Ophthalmology
                BioMed Central (London )
                1471-2415
                11 February 2016
                11 February 2016
                2016
                : 16
                : 18
                Affiliations
                [ ]Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chun-Shan S. Rd., Taipei City, 100 Taiwan
                [ ]College of Medicine, National Taiwan University, No.1 Jen-Ai Rd. Sec. 1, Taipei City, 100 Taiwan
                Article
                195
                10.1186/s12886-016-0195-3
                4751724
                26868376
                376b69e7-d211-4aa0-8640-1e15e59ce61b
                © Lai et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 10 February 2015
                : 9 February 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Ophthalmology & Optometry
                foveal detachment,high myopia,foveoschisis,optical coherence tomography,posterior vitreous detachment

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