Pre-Operative and Surgical Factors Influencing Outcomes of Vitrectomy for Myopic Foveoschisis.

Background

To evaluate the surgical outcomes of pars plana vitrectomy (PPV) for myopic foveoschisis (MF), focusing on the impact of baseline traction and atrophy severity, internal limiting membrane (ILM) peeling techniques and tamponade selection on anatomical and functional recovery.

Methods

This retrospective consecutive case series included 87 eyes undergoing PPV for MF. Myopic traction maculopathy (MTM) severity was graded using the ATN classification, and eyes were stratified by surgical technique (conventional ILM peel vs. fovea-sparing ILM peel or ILM flap). The primary outcome was complete anatomical resolution of foveoschisis on OCT at 6 months. Secondary outcomes were best-corrected visual acuity (BCVA, logMAR) and central macular thickness (CMT) at 12 months. Tertiary outcomes included postoperative complications. Furthermore, multivariable linear regression analyses were performed to identify significant independent prognostic factors associated with BCVA at 12 months.

Results

Mean age was 65.1 ± 8.9 years and mean axial length was 29.8 ± 2.0 mm. Complete anatomical resolution of foveoschisis was achieved in 93.1% of eyes at 6 months. Functional and anatomical recoveries were comparable between conventional peeling and fovea-sparing techniques (including ILM flaps). Final absolute visual acuity varied significantly across tamponade categories (p = 0.0033), reflecting baseline disease severity and the preferential selection of heavier or longer acting agents for more advanced cases. Multivariable regression identified baseline visual acuity, axial length and the use of C3F8 gas tamponade as significant independent predictors of poorer final visual outcomes.

Conclusion

Outcomes for MF are influenced heavily by baseline characteristics. Significant visual and anatomical improvement can be achieved across all surgical techniques and tamponade categories without compromising ultimate recovery.