The Importance of Posterior Hyaloid Removal in a Case of Vitrectomy for Floaters in High Myopia

TL;DR

A patient with high myopia and floaters required vitrectomy, highlighting the importance of posterior hyaloid removal to prevent foveoschisis.

Contribution

The study emphasizes the necessity of posterior hyaloid removal and ILM peeling to prevent foveoschisis progression in myopic patients undergoing vitrectomy.

Findings

Bilateral YAG laser vitreolysis failed to alleviate floaters in a patient with high myopia.

Posterior hyaloid removal and ILM peeling during vitrectomy successfully restored foveal architecture.

Preoperative OCT assessment is crucial to prevent worsening foveoschisis in myopic patients.

Abstract

A 61-year-old Malaysian Chinese man who has high myopia complained of both eye floaters. Spectral-domain optical coherence tomography (SD-OCT) of the macula showed bilateral posterior staphyloma with right eye (RE) foveoschisis without macula detachment, which had been stable for a seven-year follow-up. When bilateral YAG laser vitreolysis could not alleviate his symptoms, he underwent pars plana vitrectomy with the inducement of posterior vitreous detachment, first in the left eye, followed by the RE one month later. The best-corrected visual acuity for both eyes was 6/6, N5 two months postoperatively, and he was asymptomatic for floaters. However, six months postoperatively, he complained of metamorphopsia and worsening RE vision. Repeat OCT showed worsening of the foveoschisis bilaterally with left foveal detachment. The patient had to undergo a repeat vitrectomy with peeling of the internal limiting membrane (ILM) in bilateral eyes, which successfully restored his foveal architecture and alleviated his symptoms. This article highlights theimportance of preoperative OCT assessment of the fovea in patients undergoing vitrectomy for floaters, as staining and complete removal of posterior hyaloid with ILM peeling during vitrectomy may mitigate the progression of foveoschisis after core vitrectomy for floaters in myopic patients.

Figures