For Patients With Myopic Foveoschisis, Fovea-Sparing Peeling Shows Better Results

UNDATED PHOTO: Dr. Henry Kaplan, at Washington University, removes scar tissue from the back of an eyeball by going into the eye through an incision in the patient’s retina 1992 in Saint Louis, Missouri. It is widely believed that sight is the most complex of the five senses. It is also often thought to be our most valued, so much so that scientists are engaged in a constant endeavor to fully understand sight so that they may better fight the seemingly endless battle against blindness. (Photo by Joe McNally/Getty Images)
Investigators compared outcomes of two methods of internal limiting membrane peeling for these patients.

When compared with total peeling of internal limiting membrane for the treatment of myopic foveoschisis, fovea-sparing peeling may contribute to a better visual outcome and lower risk of postoperative myopic foveoschisis development, according to a study published in Ophthalmology Retina.

Because fovea-sparing peeling of the internal limiting membrane has been linked to reductions in the risk of postoperative macular hole, a serious complication with poor visual prognosis following surgery for myopic foveoschisis, the investigators sought to learn more about the procedure’s effects. The study was a systematic review and meta-analysis of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE. It looked at postoperative best-corrected visual acuity (BCVA) and frequency of postoperative myopic foveoschisis development as primary outcome measures between fovea-sparing peeling and total peeling of internal limiting membrane in pars plana vitrectomy for myopic foveoschisis treatment. A total of 8 non-randomized and observational studies including 300 eyes of 289 patients were used. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system determined certainty of evidence.

Investigators found that postoperative BCVA was significantly better in eyes treated with fovea-sparing peeling (MD, -0.15 logMAR; 95% CI, -0.24 to -0.05; P =.002). The fovea-sparing peeling group also had a significantly lower risk of postoperative myopic foveoschisis (odds ratio [OR], 0.19; 95% CI, 0.06 to 0.56; P =.003). No significant difference in postoperative central foveal thickness (MD, 6.22 μm; 95% CI, -14.2to 26.7; P =.94) was found, the report shows. 

“The certainty of evidence regarding lower frequency of postoperative [myopic foveoschisis] after [fovea-sparing] peeling was considered moderate, while the certainty regarding better postoperative BCVA after [fovea-sparing] peeling was judged as low,” according to the study.

Limitations of the research include that none of the included studies were randomized, which had a variety of possible implications, but “considering the scarcity” of myopic foveoschisis, a large-scale randomized study that evaluates the efficiency of the fovea-sparing technique might prove challenging into the future.

“Our data indicated that fovea-sparing in internal limiting membrane peeling could significantly decrease the risk of postoperative macular hole development, and lead to more favorable postoperative BCVA after surgery,” according to investigators. “There was no significant difference in postoperative central foveal thickness between 2 groups.”


Azuma K, Hirasawa K, Araki F, et al. Fovea-sparing as opposed to total peeling of internal limiting membrane for myopic foveoschisis: A systematic review and meta-analysis. Ophthalmol Retina. Published online December 9, 2020. doi:10.1016/j.oret.2020.10.010