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The effectiveness and safety of posterior scleral reinforcement with vitrectomy for myopic foveoschisis treatment: a systematic review and meta-analysis

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To investigate the effectiveness and safety of posterior scleral reinforcement (PSR) combined with vitrectomy for myopic foveoschisis (MF) treatment.

Methods

We conducted a systematic review and meta-analysis. We evaluated the improvement of best-corrected visual acuity (BCVA) in logMAR unit, the percentage of patients with improved or stabled BCVA, benefit on axial length (AL), the retinal reattachment rate, the macular hole (MH) closure rate, as well as the complication rate.

Results

Fourteen studies (311 eyes) were included. Overall, patients’ BCVA improved − 0.46 (95% confidence interval [CI] − 0.52, − 0.40) logMAR unit, with 80% (95%CI 74%, 85%) benefiting from BCVA improvement and 6% (95%CI 3%, 10%) suffering from BCVA loss. Patients’ AL was shortened by − 1.74 (95%CI − 2.92, − 0.57) mm, and for patients whose AL was ≥ 30 mm, the average benefit reached − 3.68 (95%CI − 4.59, − 2.77) mm. Ninety-three percent (95%CI 89%, 96%) of the patients achieved retinal reattachment, and 65% (95%CI 47%, 80%) of the MH was closed. Patients’ central foveal thickness decreased; the MD was − 187.32 (95%CI − 206.25, − 168.40) mm. The pooled complication rate was 9% (95%CI 8%, 19%), with extrusion, choroidal atrophy, and choroidal neovascularization being the most common complications. Subgroup analysis indicated no statistical difference in BCVA improvement, AL change, retinal reattachment rate, and complication rate between patients with or without MH. Subgroup analysis indicated no statistical difference in the above four outcomes between the primary and the recurrent patients either. There was no statistical difference in the above four outcomes no matter ILM peeling was combined or not.

Conclusion

PSR combined with vitrectomy helps improve 80% MF patients’ BCVA; the average benefit on BCVA is − 0.46 logMAR unit. The average change in AL is − 1.74 mm; patients with AL ≥ 30 mm benefit much more than the patients with AL < 30 mm. The retinal reattachment rate is up to 93%; the MH closure rate is 65%. About 9% patients will suffer from extrusion, choroidal atrophy, choroidal neovascularization, and other complications. The outcomes were not influenced by presence of MH, disease recurrence, or ILM peeling.

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Financial support

This study was funded by the National natural science fund (grant number 30471861).

Author information

Authors and Affiliations

  1. Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, No17, Hougou ally, Dongcheng District, Beijing, China

    Kai Cao, Jinda Wang, Jingshang Zhang, Mayinuer Yusufu, Shanshan Jin, Guyu Zhu, Hailong He & Xiu Hua Wan

  2. Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital of Capital Medical University, Beijing, China

    Yue Qi

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  1. Kai Cao
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Contributions

Study design and concept (Xiu Hua Wan, Jinda Wang, Jingshang Zhang, Kai Cao); database search (Kai Cao, Shanshan Jin); data extracting (Kai Cao, Shanshan Jin); data analysis (Kai Cao); manuscript writing (Kai Cao, Xiu Hua Wan); manuscript revising (Mayinuer Yusufu, Xiaoxia Li, Guyu Zhu, Hailong He).

Corresponding author

Correspondence to Xiu Hua Wan.

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Conflict of interest

Author Kai Cao declares that he has no conflict of interest. Author Jinda Wang declares that he has no conflict of interest. Author Jingshang Zhang declares that he has no conflict of interest. Author Mayinuer Yusufu declares that she has no conflict of interest. Author Shanshan Jin declares that she has no conflict of interest. Author Guyu Zhu declares that she has no conflict of interest. Author Hailong He declares that he has no conflict of interest. Author Yue Qi declares that she has no conflict of interest. Author Xiu Hua Wan has received research grants from the National Natural Science Foundation of China.

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Appendix

Appendix

Appendix 1. Search strategy

((“sclera”[MeSH Terms] OR “sclera”[All Fields] OR “scleral”[All Fields]) OR (“sclera”[MeSH Terms] OR “sclera”[All Fields]) OR (posterior[All Fields] AND (“sclera”[MeSH Terms] OR “sclera”[All Fields] OR “scleral”[All Fields]) AND (“reinforcement (psychology)”[MeSH Terms] OR (“reinforcement”[All Fields] AND “(psychology)”[All Fields]) OR “reinforcement (psychology)”[All Fields] OR “reinforcement”[All Fields])) OR (“Policy Stud Rev”[Journal] OR “Pac Sociol Rev”[Journal] OR “psr”[All Fields]) OR buckle[All Fields] OR buckling[All Fields] OR (gas[All Fields] AND tamponade[All Fields]) OR ((“membranes”[MeSH Terms] OR “membranes”[All Fields] OR “membrane”[All Fields]) AND peeling[All Fields]) OR ERM[All Fields] OR ILM[All Fields]) AND ((“vitrectomy”[MeSH Terms] OR “vitrectomy”[All Fields]) OR (“vitrectomy”[MeSH Terms] OR “vitrectomy”[All Fields] OR “vitrectomies”[All Fields]) OR (pars[All Fields] AND plana[All Fields] AND (“vitrectomy”[MeSH Terms] OR “vitrectomy”[All Fields])) OR ppv[All Fields]) AND ((“retinoschisis”[MeSH Terms] OR “retinoschisis”[All Fields]) OR foveoschisis[All Fields] OR (macular[All Fields] AND cleft[All Fields]) OR (macular[All Fields] AND split[All Fields]) OR ((“retinal perforations”[MeSH Terms] OR (“retinal”[All Fields] AND “perforations”[All Fields]) OR “retinal perforations”[All Fields] OR (“macular”[All Fields] AND “hole”[All Fields]) OR “macular hole”[All Fields]) OR (“retinal detachment”[MeSH Terms] OR (“retinal”[All Fields] AND “detachment”[All Fields]) OR “retinal detachment”[All Fields]))) AND ((pathologic[All Fields] AND (“myopia”[MeSH Terms] OR “myopia”[All Fields])) OR (high[All Fields] AND (“myopia”[MeSH Terms] OR “myopia”[All Fields])) OR (“myopia”[MeSH Terms] OR “myopia”[All Fields] OR “myopic”[All Fields]))

Fig. 8
figure 8

Subgroup analysis of best-corrected visual acuity in logMAR unit by macular hole

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Fig. 9
figure 9

Subgroup analysis of best-corrected visual acuity in logMAR unit by recurrence

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Fig. 10
figure 10

Subgroup analysis of best-corrected visual acuity in logMAR unit by internal limiting membrane peeling

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Fig. 11
figure 11

Forest plot of number of best-corrected visual acuity improvement

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Fig. 12
figure 12

Forest plot of number of improved or stabled best-corrected visual acuity

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Fig. 13
figure 13

Forest plot of number of best-corrected visual acuity loss

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Fig. 14
figure 14

Forest plot of the retinal reattach rate after trim and fill

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Fig. 15
figure 15

Subgroup analysis of the retinal reattachment rate by macular hole

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Fig. 16
figure 16

Subgroup analysis of the retinal reattachment rate by recurrence

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Fig. 17
figure 17

Subgroup analysis of the complication rate by macular hole

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Fig. 18
figure 18

Subgroup analysis of the complication rate by recurrence

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Cao, K., Wang, J., Zhang, J. et al. The effectiveness and safety of posterior scleral reinforcement with vitrectomy for myopic foveoschisis treatment: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 258, 257–271 (2020). https://doi.org/10.1007/s00417-019-04550-5

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