# A technique of TA-assisted ILM peeling for myopic foveoschisis

## TL;DR

This study evaluates the effectiveness of using Triamcinolone Acetonide (TA) to assist in peeling the internal limiting membrane during treatment of myopic foveoschisis, finding it to be a feasible approach.

## Contribution

The study introduces TA-assisted ILM peeling as a novel technique for treating myopic foveoschisis and compares it with ICG-assisted methods.

## Key findings

- TA-assisted FILMP is feasible for ILM peeling in myopic foveoschisis due to TA's strong adhesion to the vitreous cortex.
- Postoperative visual acuity and retinal thickness improved significantly compared to preoperative values.
- There were no significant differences between TA and ICG groups in outcomes like macular hole incidence or visual acuity.

## Abstract

To evaluate the clinical effects of using Triamcinolone Acetonide (TA) in fovea-sparing internal limiting membrane peeling (FILMP) technique for treating myopic foveoschisis (MF).

This prospective study recruited 66 (72 eyes) non-consecutive patients diagnosed with MF from June 2018 to November 2020. All patients underwent FILMP combined with 25G pars plana vitrectomy (PPV). Based on the staining agents used during FILMP, patients were divided into the TA group and the indocyanine green (ICG) group. Preoperative and follow-up assessments included visual acuity, best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp examination of the anterior and posterior segments, optical coherence tomography (OCT), ultra-widefield fundus photography, and B-scan ultrasonography. Postoperative visual acuity, central retinal thickness (CRT), postoperative recovery of MF, and the incidence of postoperative full-thickness macular hole (MH) were compared between the two groups.

The mean age of patients was 56.16 ± 11.00 years (19 males and 47 females); the mean axial length was 30.50 ± 1.96 mm and the mean follow-up duration was 13.89 ± 8.32 months. Six patients underwent binocular surgery due to bilateral MF, while the remaining 60 patients underwent monocular surgery. Forty-four eyes received TA-assisted FILMP, and the remaining 28 eyes received ICG-assisted FILMP. A total of 65 patients, accounting for 90.3% (26 patients in the ICG group and 39 patients in the TA group), were treated with a 20% C3F8 tamponade. 40 patients, accounting for 69.4% (23 patients in the ICG group and 27 patients in the TA group), received combined 20% C3F8 tamponade and Phaco + IOL implantation. The total incidence of the postoperative full-thickness MH with FILMP was 4.9%. The mean postoperative logMAR visual acuity significantly improved compared to preoperative values (1.00 ± 0.62 vs. 1.67 ± 0.67, p < 0.01). Postoperative CRT was significantly thinner than the preoperative CRT (295.88 ± 167.55 μm vs 473.47 ± 195.96 μm, p < 0.01). There were no significant differences between the TA and ICG groups in the postoperative incidence of full-thickness MH, logMAR visual acuity, CRT, or MF recovery.

Due to the strong adhesion of the posterior cortical vitreous, the internal limiting membrane (ILM) is difficult to stain with ICG. In contrast, TA can adhere well to the vitreous cortex and remain on the macular surface in eyes with MF. TA-assisted FILMP is a feasible approach for ILM peeling in MF. Large-sample, prospective and randomized controlled trials are needed to confirm these findings.

Chinese Clinical Trial Registry, ChiCTR2200060265, 2022–05-24, Retrospectively registered.