Potent retinal arteriolar traction as a possible cause of myopic foveoschisis

Purpose

To report retinal microfold formation after vitrectomy for myopic foveoschisis (MF).

Design

Prospective observational study.

Methods

We observed 21 eyes of 17 patients who had undergone vitrectomy for MF with optical coherence tomography (OCT) in this institutional study. We also evaluated the three-dimensional retinal architecture using the OCT-ophthalmoscope in selected cases. Vitrectomy included core vitrectomy, vitreous cortex removal, internal limiting membrane (ILM) peeling with indocyanine green, and gas tamponade.

Results

Horizontal linear folds were commonly observed postoperatively. The folds, which were 1,000 to 2,000 μm superior, inferior, or both superior and inferior to the fovea, were detected only by OCT and not by conventional slit-lamp-based biomicroscopy. The microfolds were found in only five eyes (24%) 1 month postoperatively. The incidence increased over time, however, and a microfold was detected in nine eyes (43%) 3 months after surgery and in 13 (62%) 6 months after surgery. OCT-ophthalmoscope examination confirmed the location of the microfold coincided exactly with that of retinal arteriole. The presence of microfolds was not significantly related to the postoperative visual acuity.

Conclusions

Retinal microfolds are common in eyes with MF after vitrectomy with ILM peeling, and they seem to be generated as the result of insufficient flexibility of the sclerotic retinal arteriole during axial length elongation in highly myopic eyes. This finding suggests that the inward tractional force on the retina along the arteriole may be closely related to the pathogenesis of vitreoretinal diseases specific to high myopia, including MF or paravascular microhole formation.