1

The author has no potential

conflict of interest to disclose

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Modificazioni Vitreo-Retiniche negli Stafilomi nel Miope Elevato ed Eventuali

Indicazioni Chirurgiche.

Guido Ripandelli

Tommaso Rossi*

Fabio Scarinci

Mario StirpeIRCCS – Fondazione Bietti, Roma*Ospedale Oftalmico, Roma

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Macular Vitreo-Retinal InterfaceAbnormalities in Highly Myopic Eyes with

Posterior Staphyloma:5-Years Follow-Up.

Guido Ripandelli, Tommaso Rossi, * Fabio Scarinci, Cecilia Scassa, Vincenzo Parisi, Mario Stirpe.

Retina 2012;32:1531-8.

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• Purpose: to review prevalence, long-term progression and prognosis of VR interface modifications in highly myopic eyes with posterior staphyloma

When surgery is necessary?

Which is the best timing for surgery?

• Study design: retrospective, single Institution series

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Patients’ characteristics

• December 1999 - December 2004

• 408 phakic eyes / 204 subjects

• 108 Males / 96 Females

• Age 22-58 years

• Myopia 18-30 D and PS (Axial lenght 30-34 mm)

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Inclusion Criteria

• AL > 30 mm

• Presence of posterior staphyloma

• Availability of OCT, MP1 at baseline, at latest examination, (before and after surgery)

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Exclusion Criteria

Patients with incomplete charts, lost at follow-up, with significant media opacities, with previous ocular surgery

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Characteristics of patients with VR changes

• Prevalence of posterior VR changes: 236/408 (57.8%) eyes

• Minimum follow-up: 5 years

• Lost to follow-up: 22/236 eyes (9.3%)

• Included in the study: 214 eyes (116 subjects)

– Bilateral VR changes 98/116 (84.4%)

– 54 males /62 females

– Age 24-59 years

– Myopia 19-30 D (29.5-34 mm)

– 209 eyes: visual acuity 20/50-20/20

– 5 eyes: C F – 20/100

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Testing

• Visual acuity (VA)

• Biomicroscopy

• Optical Coherence Tomography (OCT)

• MP1 Microperimetry

• A, B-scan ultrasound

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Group 1 Epiretinal membrane without retinal changes (EM) : 98 eyes

Group 2 Macular schisis with/without epiretinal membrane (MSEM): 54 eyes

Asymptomatic macular schisis with EM (AMSEM, 33 eyes)

Symptomatic macular schisis with EM (SMSEM, 14 eyes)

Posterior stretch schisis (PSS, 7 eyes)

Group 3 Partial thickness macular hole (PTMH): 24 eyes

PTHM with retinal schisis (15 eyes)

PTHM without retinal schisis (9 eyes)

Group 4 Full thickness macular hole (FTMH): 18 eyes

Asymptomatic full thickness macular hole (AFTMH, 9 eyes)

Symptomatic full thickness macular hole (SFTMH, 9 eyes)

Group 5 Posterior retinal detachment (PRD): 20 eyes

PRD with macula on (PRD M-on, 11 eyes)

PRD with macula off (PRD M-off, 4 eyes)

PRD with macular hole (PRDMH, 5 eyes)

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Gr. 1 Epiretinal membrane without retinal changes (EM)

98 eyes (45.7%)

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Gr. 2 Macular schisis with/without epiretinal membrane (MSEM, 54 eyes)

Asymptomatic macular schisis with epiretinal membrane (AMSEM)

33 eyes (15.4%)

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Symptomatic macular schisis with epiretinal membrane (SMSEM)

14 eyes (6.5%)

Gr. 2 Macular schisis with/without epiretinal membrane (MSEM, 54 eyes)

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Posterior stretch schisis (PSS)

7 eyes (3.3%)

Gr. 2 Macular schisis with/without epiretinal membrane

(MSEM, 54 eyes)

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Gr. 3 Partial thickness macular hole ( PTMH, 24 eyes)

PTMH with macular schisis

15 eyes (7%)

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Gr. 3 Partial thickness macular hole ( PTMH, 24 eyes)

PTMH without macular schisis

9 eyes (4.2%)

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Asymptomatic full thickness macular hole (AFTMH)

9 eyes (4.2%)

Gr. 4 Full thickness macular hole ( FTMH, 18 eyes)

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Symptomatic full thickness macular hole (SFTMH)

9 eyes (4.2%)

Gr. 4 Full thickness macular hole ( FTMH, 18 eyes)

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PRD in the staphyloma area with macula on (PRD M-on)

11 eyes (5.1%)

Gr. 5 Posterior retinal detachment (PRD, 20 eyes)

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PRD in the staphyloma area with macula off (PRD M-off)

4 eyes (1.8%)

Gr. 5 Posterior retinal detachment (PRD, 20 eyes)

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PRD with macular hole (PRDMH)

5 eyes (2.3%)

Gr. 5 Posterior retinal detachment (PRD, 20 eyes)

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Evolution to pathologies requiring surgery: 24/205 (11.7%)(9 PRD eyes underwent surgery upon presentation)

Gr. 1 Epiretinal membrane without retinal changes (EM) : 2/98 (2V)

Gr. 2 Asymptomatic macular schisis (AMSEM): 6/33 (3V, 3V+PB)

Symptomatic macular schisis (SMSEM): 7/14 (4V, 3V+PB)

Posterior stretch schisis (PSS): 0/7 -

Gr. 3 PTHM with macular schisis (PTMH-MS): 5/15 (3V, 2V+PB)

PTMH without macular schisis (PTMH-w/o MS): 0/9 -

Gr. 4 Asymptomatic macular hole (AFTMH): 2/9 (2V)

Symptomatic macular hole (SFTMH): 1/9 (1V)

Gr. 5 PRD in staphyloma area / macula ON (PRD M-on): 1/11 (1V)

PRD in staphyloma area/ macula off (PRD M-off): 4/4 (2V, 2V+PB)

PRD with macular hole (PRD-MH): 5/5 (2V, 3V+PB)

V= vitrectomy, PB= posterior buckle

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Observations

High myopia with posterior staphyloma can be associated with a broad spectrum of vitreoretinal alterations and represents an elusive nosological entity, whose natural history, progression, therapeutic options and surgical timing remain uncertain.

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Observations

• High myopic eyes with posterior staphyloma show high frequency of vitreoretinal alterations (57.8%)

• Bilateral vitreoretinal changes on 84.5% patients

• Anatomical changes and visual acuity remain in most cases unchanged over time

• In evolutive cases the evolution is quite slow

• OCT and MP1 fundamental exams for diagnosing and follow-up

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Observations

• Microperimetry provides important data for a timely surgical decision

• Foveal sensitivity decrease and worsening of fixation stability are significantly associated to the need for surgery.

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Observations• The decrease of sensitivity explored by MP1 is

a sign that may precede the objective worsening of visual acuity

VA 20/25 VA 20/25

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•Surgical removal of ER tissue represents the first attempt to resolve the pathology

Observations

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• The reduction of posterior staphyloma by means of posterior buckle is a method to use to repair the unsuccessfull cases

Observations

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Observations

Vitreoretinal interface alterations in highly myopic eyes have not been univocally classified yet and the concept itself of disease progression and surgical indication are largely debatable and deserve standardization.

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Observations

Foveal sensitivity and fixation patterns are associated to a variable risk of progression and visual prognosis differssignificantly among groups. We believe this variability represents underlying separate pathologies that warrant diversified treatment.