Abstract
Purpose
To analyse optical coherence tomography (OCT) biomarkers of anatomical and functional success in myopic foveoschisis (MF) (stage I and II of ATN classification) undergoing pars plana vitrectomy (PPV).
Materials and methods
Isolated MF cases who underwent PPV showing preoperative optical coherence tomography (OCT)-documented integrity of the foveal ellipsoid zone (EZ) and retinal pigmented epithelium (RPE) were included. Availability of good quality preoperative and 1-year-postoperative OCT acquisitions was also mandatory for inclusion. Anatomical success was defined as persistence of <20% of preoperative cystoid spaces within the parafoveal region and preservation of the foveal EZ and RPE. Functional success was defined as postoperative improvement of at least 10 ETDRS letters.
Results
Anatomical success was obtained in 86.1% cases (31/36). A significantly higher prevalence of preoperative choroidal hypertransmission (CH) with preserved EZ and RPE was detected in the anatomical failure group. Functional success was reported in 72.2% of cases. A larger diameter of preoperative foveal cysts and the presence of a cotton ball sign were associated with a worse functional outcome. Dome shaped macula (DMS) was associated to a good anatomical and functional outcome.
Conclusions
Our retrospective analysis highlighted that the preoperative presence of a foveal CH with preserved foveal EZ and RPE might be predictive a postoperative anatomical and functional failure in MF surgery. By contrast, a larger diameter of foveal cysts might be associated to functional failure despite anatomical success, while DMS might be a predictor of good prognosis. Assessment of the described biomarkers on a larger prospective cohort is needed to validate our findings.
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Fig. 1: CH with irregular foveal EZ and RPE as a relevant anatomical and functional biomarker.
Fig. 2: Preoperative foveal cysts width is a predictor of functional success in MF.
Data availability
Data are available upon reasonable request to the Corresponding Author
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Acknowledgements
Italian Ministry of Health – RC 2025.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
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Authors and Affiliations
Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, Rome, Italy
Emanuele Crincoli, Alfonso Savastano, Maria Cristina Savastano, Umberto De Vico, Matteo Maria Carlà, Federico Giannuzzi & Stanislao Rizzo
Department of Ophthalmology, University of Pisa, Pisa, Italy
Clara Rizzo
Ophthalmology Unit, University of Verona, Verona, Italy
Raphael Kilian
Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence and AOU Careggi, Firenze, Italy
Ilaria Biagini
Authors
Emanuele Crincoli
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2. Alfonso Savastano
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3. Maria Cristina Savastano
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4. Clara Rizzo
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5. Raphael Kilian
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6. Umberto De Vico
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7. Ilaria Biagini
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8. Matteo Maria Carlà
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9. Federico Giannuzzi
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10. Stanislao Rizzo
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Contributions
Design of the study: EC, SR; Analysis: CR, RK, MMC; Interpretation: AS, UDV, MCS, FG, IB; Draft: EC; Revision: EC, AS, MMS, CR, RK, UDV, IB, MMC, FG, SR.
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Correspondence to Alfonso Savastano.
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The study adhered to the declaration of Helsinki and the protocol was approved by the Ethics Committee of Università Cattolica del Sacro Cuore di Roma.
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Crincoli, E., Savastano, A., Savastano, M.C. et al. Diameter of cystoid spaces and choroidal hypertransmission as novel prognostic biomarkers in myopic foveoschisis. Eye (2025). https://doi.org/10.1038/s41433-025-03738-w
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Received:25 February 2024
Revised:07 January 2025
Accepted:19 February 2025
Published:17 March 2025
DOI:https://doi.org/10.1038/s41433-025-03738-w
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