Aa
Foveoschisis
(Posted also as comment in another topic)
"Glad" to hear i am not the only one. My myopia problems started at 6. By the time i was 16 it stabilised at around -18 diopters ( contact lenses). My condition remained stable up to the age of 42 until almost overnight Instarted seeing all lines bent, all shapes distorted both veryically & horizontally in my good eye ( the other one has a vision of 5/10 corrected.) the situation remained stable for over 1,5 years when cataracts developed , dropping the vision to my good eye to 3/10 corrrected). Cataract surgery improved the vision to 11/10! But lasted only for 2 months. I started seeing zebra like stripes in all shining surfaces , then a stable cobweb. The parlial PVD diagnosed 2 years ago caused extensive makular traction and eventually foveoschisis. My doctor advised me vitrectomy with ILM peeling and gas tamponade. I just cancelled the operation scheduled out of fear of the outcome since if I lose the 8/10 vison i know have i wont be able to work ( in front of a computer the whole day). I am seeking other opinions, one stating that foveoschisis should be observed until it causes a retina detachemnt or vision deteriorates to 3/10. In the last 4 days the big shadow in my area of focus moved away , or shifted , my floaters are that big and very little moving that obstract me heavily when i read covering some letters , almost making them partially dissapear. I have huge posterior staphylomas and axial lengths of 33&36 .Any advice?
"Glad" to hear i am not the only one. My myopia problems started at 6. By the time i was 16 it stabilised at around -18 diopters ( contact lenses). My condition remained stable up to the age of 42 until almost overnight Instarted seeing all lines bent, all shapes distorted both veryically & horizontally in my good eye ( the other one has a vision of 5/10 corrected.) the situation remained stable for over 1,5 years when cataracts developed , dropping the vision to my good eye to 3/10 corrrected). Cataract surgery improved the vision to 11/10! But lasted only for 2 months. I started seeing zebra like stripes in all shining surfaces , then a stable cobweb. The parlial PVD diagnosed 2 years ago caused extensive makular traction and eventually foveoschisis. My doctor advised me vitrectomy with ILM peeling and gas tamponade. I just cancelled the operation scheduled out of fear of the outcome since if I lose the 8/10 vison i know have i wont be able to work ( in front of a computer the whole day). I am seeking other opinions, one stating that foveoschisis should be observed until it causes a retina detachemnt or vision deteriorates to 3/10. In the last 4 days the big shadow in my area of focus moved away , or shifted , my floaters are that big and very little moving that obstract me heavily when i read covering some letters , almost making them partially dissapear. I have huge posterior staphylomas and axial lengths of 33&36 .Any advice?
An update:
I saw another doctor in London that i am located now.
He diagnosed foveoschisis in both eyes, completely asymptomatic on the right eye (vision since cataract surgery 5/10 which is the best I have ever had in that :lazy eye)
He recommended to wait 4 weeks and see if the symptoms in my left (good)
eye get worse, stabilize or improve. Vision 8/10 as 1 month ago, down form 10/10 2 months ago when I had the 1st symptoms.
His advice is that the risks in vitrectomy/ILM peeling are big enough in my case since I have 1 good eye to risk surgery, should do it only if it gets worse and I have no choice since there are no guarantees for improvement /worsening with or without surgery. He also said it is up to me to decide, asked me if I can live with that and I said :Yes.
Current situation since last week: the shadow in my point of focus has dissipated and I can read (e.g. bottle labels when 1 week ago I could not ), I also can read on the opposite side of the train when I commute (most part of the words that are small enough).
What remains there is the visual effects that take the shape of "worn out" edges of illuminated surfaces and the "volatility" in lights-when i look at a lighting fixture there are things like flame bursts coming out and if they are at a great distance, they look like the small firework type of candles they put in cocktail drinks.. I I keep my eyes without moving , they settle and I can see the light behind in its proper shape.
the cobweb effect when i quickly move my eyes reappeared and computer fonts seem at times pixelated, but no always. I guess all these are caused by a combination of PVD -seeing the out edges (cobweb) and continuous stimulation on the retina by the traction
I chickened out before the scheduled surgery since I was having no answers on a variety of questions I had by my permanent doctor and I cannot jeopardise my one and only good eye without second though.
I hope I have made the right decision
I saw another doctor in London that i am located now.
He diagnosed foveoschisis in both eyes, completely asymptomatic on the right eye (vision since cataract surgery 5/10 which is the best I have ever had in that :lazy eye)
He recommended to wait 4 weeks and see if the symptoms in my left (good)
eye get worse, stabilize or improve. Vision 8/10 as 1 month ago, down form 10/10 2 months ago when I had the 1st symptoms.
His advice is that the risks in vitrectomy/ILM peeling are big enough in my case since I have 1 good eye to risk surgery, should do it only if it gets worse and I have no choice since there are no guarantees for improvement /worsening with or without surgery. He also said it is up to me to decide, asked me if I can live with that and I said :Yes.
Current situation since last week: the shadow in my point of focus has dissipated and I can read (e.g. bottle labels when 1 week ago I could not ), I also can read on the opposite side of the train when I commute (most part of the words that are small enough).
What remains there is the visual effects that take the shape of "worn out" edges of illuminated surfaces and the "volatility" in lights-when i look at a lighting fixture there are things like flame bursts coming out and if they are at a great distance, they look like the small firework type of candles they put in cocktail drinks.. I I keep my eyes without moving , they settle and I can see the light behind in its proper shape.
the cobweb effect when i quickly move my eyes reappeared and computer fonts seem at times pixelated, but no always. I guess all these are caused by a combination of PVD -seeing the out edges (cobweb) and continuous stimulation on the retina by the traction
I chickened out before the scheduled surgery since I was having no answers on a variety of questions I had by my permanent doctor and I cannot jeopardise my one and only good eye without second though.
I hope I have made the right decision
few more questions:
Will vitrectomy remove all my eye gel=goodbye floaters. I know I also have vitrous condensation which contributes partly to my worsening vision.
On the lazy eye now that achieved a 5/10 after cataract surgery and when my problems started 2.5 years ago I saw permanent flashes (cannot describe it properly and cant remember but I think I looked at something very shiny that remained there as flash for minutes). A month later I discovered that these areas of the "flash" turned grey , I still see them grey on the upper part of visual field while the whole thing takes the shape of a vortex, something like a reversed "@" without the "a" in the middle but in perfect form. Is is a a scotoma, a leak, a permanent floater a shadow of the traction, an atrophy ? OCT and fluoroangiography showed nothing . Something similar exists in my left eye, like two lines extending from the normal blind spot almost merging but stopping at my central vision spot .It started as a very white area which expanded in a few days, then stopped. (this is where I almost suffered a nervous breakdown as I though it will cover my central vision rendering me completely unable to live, work etc)
Will vitrectomy remove all my eye gel=goodbye floaters. I know I also have vitrous condensation which contributes partly to my worsening vision.
On the lazy eye now that achieved a 5/10 after cataract surgery and when my problems started 2.5 years ago I saw permanent flashes (cannot describe it properly and cant remember but I think I looked at something very shiny that remained there as flash for minutes). A month later I discovered that these areas of the "flash" turned grey , I still see them grey on the upper part of visual field while the whole thing takes the shape of a vortex, something like a reversed "@" without the "a" in the middle but in perfect form. Is is a a scotoma, a leak, a permanent floater a shadow of the traction, an atrophy ? OCT and fluoroangiography showed nothing . Something similar exists in my left eye, like two lines extending from the normal blind spot almost merging but stopping at my central vision spot .It started as a very white area which expanded in a few days, then stopped. (this is where I almost suffered a nervous breakdown as I though it will cover my central vision rendering me completely unable to live, work etc)
Thank you very much for the extensive reply. I am located in London for the time being, just moved here, my permanent doctor is in Greece though and this is where I will be having the surgery.It seems that my staphylomas are stable, the traction is caused mainly by the Vitreous gel that is condensed and pulling the retina layers than staphylomas expanding backwards. (at least this is what I understand). As far as the IOLs are concerned i was hoping that since the the retina layers move back it will alleviate the need for reading glasses that I need since the cataract surgery, actually becoming more myopic. Thanks again
Cynomad, I am sorry to read about your problems with foveoschisis. Unfortunately in patients like you it don't believe it is all that unusual a problem.
I have degenerative myopia with axial lengths just over 30mm, posterior staphylomas, and had my first distortion/blurring episode this past summer. I understand your hesitation about the vitrectomy surgery, as all of these procedures are frightening to contemplate - and the risk of possibly losing what vision one does have is very upsetting.
Knowing I will likely have a similar episode at some point, I have been reading about the treatment options for myopic macular schisis. It sounds like ILM peeling/vitrectomy/tamponade is the currently favored treatment for this condition. However, I recently came across two different sources who advocated for external 'buckling' or rear external support of the macular area in these cases, rather than first relying in vitrectomy:
#1 - 2013 publication by Dr. Brian Ward in the journal 'Retina,' concerning the use of posterior pole buckle surgery to address cases of macular schisis caused by high myopia. Here is a link if you would like to read it:
http://www.retinaldiagnostic.com/uploads/3/3/3/7/3337118/brianwardretinapaper.pdf
As a non-doctor reading this article, it sounds like Dr. Ward's primary approach to treating macular schisis is to graft supporting tissue onto the rear posterior pole of the eye, with the goal of compressing the outer scleral layer back toward the inner retinal surface. The object is to decrease separation of the retina layers as well as reduce tractional forces on the inner retinal membrane. This is achieved by suturing on a tensioned strip of scleral tissue across the tissue behind the macula, from the outside of the eye. The tension gently compresses the retina layers back together and reduces tension on the inner layer by shrinking the surface area slightly and preventing it from stretching further.
The ILM peeling and tamponade approach, in contrast, targets release of the vitreous and ILM from the retina layers, in the hope that when the traction is released, the retinal layers will relax and the gas tamponade will help force the layers back together again, all achieved from within the eye.
Both surgical approaches have risks and potential long term consequences. You may wish to search this website for patient comments about both procedures, as there are good and bad things about each.
It's possible that both surgeries might be needed for your case.
#2 - Online video presentation from European VitreoRetinal Society conference where Dr Barbara Parolini reported using an exterior buckle first to treat cases of macular detachment/macular hole/schisis. She recommended that for patients in which the holes or detachment persisted after external buckling, vitrectomy could be performed 2-3 weeks after the first surgery when it was still indicated. She said in some cases only the buckle was needed to resolve the detachment/hole/schisis of the macula. It was quite interesting; she alleged that a vitrectomy was needed only when there was remaining traction on the inner retina surface. Don't watch it if you are squeamish though.
http://www.dailymotion.com/video/x15zr16_new-indication-for-macular-buckle-in-high-myopia-barbara-parolini_tech
I believe in other countries artificial materials are used for buckling because of difficulty obtaining donor scleral material, but Dr. Ward's paper mentions his preference for donor sclera as the material of choice in the US in his opinion. Not sure where you are located.
Specifically with regard to your question about your IOL power, it seems rational that an exterior scleral buckle or support might help stabilize axial length and reduce the chance that your IOL will not continue to provide the correct spherical correction.
I would imagine that if your eyes continue to lengthen, either after a vitrectomy or independent of it, you may need modest additional correction (low-power glasses or contacts) or perhaps one day an IOL-swapping procedure to maintain your vision. However, replacing an IOL has risks too, so I wouldn't do it if there was a safer way to achieve reasonable spherical correction, especially with your high-risk eyes.
Sorry for the long post. Please keep this community updated on your case; I hope you find an approach that you are reasonably comfortable with, and that you have a good outcome. Best of luck and good wishes to you.
I have degenerative myopia with axial lengths just over 30mm, posterior staphylomas, and had my first distortion/blurring episode this past summer. I understand your hesitation about the vitrectomy surgery, as all of these procedures are frightening to contemplate - and the risk of possibly losing what vision one does have is very upsetting.
Knowing I will likely have a similar episode at some point, I have been reading about the treatment options for myopic macular schisis. It sounds like ILM peeling/vitrectomy/tamponade is the currently favored treatment for this condition. However, I recently came across two different sources who advocated for external 'buckling' or rear external support of the macular area in these cases, rather than first relying in vitrectomy:
#1 - 2013 publication by Dr. Brian Ward in the journal 'Retina,' concerning the use of posterior pole buckle surgery to address cases of macular schisis caused by high myopia. Here is a link if you would like to read it:
http://www.retinaldiagnostic.com/uploads/3/3/3/7/3337118/brianwardretinapaper.pdf
As a non-doctor reading this article, it sounds like Dr. Ward's primary approach to treating macular schisis is to graft supporting tissue onto the rear posterior pole of the eye, with the goal of compressing the outer scleral layer back toward the inner retinal surface. The object is to decrease separation of the retina layers as well as reduce tractional forces on the inner retinal membrane. This is achieved by suturing on a tensioned strip of scleral tissue across the tissue behind the macula, from the outside of the eye. The tension gently compresses the retina layers back together and reduces tension on the inner layer by shrinking the surface area slightly and preventing it from stretching further.
The ILM peeling and tamponade approach, in contrast, targets release of the vitreous and ILM from the retina layers, in the hope that when the traction is released, the retinal layers will relax and the gas tamponade will help force the layers back together again, all achieved from within the eye.
Both surgical approaches have risks and potential long term consequences. You may wish to search this website for patient comments about both procedures, as there are good and bad things about each.
It's possible that both surgeries might be needed for your case.
#2 - Online video presentation from European VitreoRetinal Society conference where Dr Barbara Parolini reported using an exterior buckle first to treat cases of macular detachment/macular hole/schisis. She recommended that for patients in which the holes or detachment persisted after external buckling, vitrectomy could be performed 2-3 weeks after the first surgery when it was still indicated. She said in some cases only the buckle was needed to resolve the detachment/hole/schisis of the macula. It was quite interesting; she alleged that a vitrectomy was needed only when there was remaining traction on the inner retina surface. Don't watch it if you are squeamish though.
http://www.dailymotion.com/video/x15zr16_new-indication-for-macular-buckle-in-high-myopia-barbara-parolini_tech
I believe in other countries artificial materials are used for buckling because of difficulty obtaining donor scleral material, but Dr. Ward's paper mentions his preference for donor sclera as the material of choice in the US in his opinion. Not sure where you are located.
Specifically with regard to your question about your IOL power, it seems rational that an exterior scleral buckle or support might help stabilize axial length and reduce the chance that your IOL will not continue to provide the correct spherical correction.
I would imagine that if your eyes continue to lengthen, either after a vitrectomy or independent of it, you may need modest additional correction (low-power glasses or contacts) or perhaps one day an IOL-swapping procedure to maintain your vision. However, replacing an IOL has risks too, so I wouldn't do it if there was a safer way to achieve reasonable spherical correction, especially with your high-risk eyes.
Sorry for the long post. Please keep this community updated on your case; I hope you find an approach that you are reasonably comfortable with, and that you have a good outcome. Best of luck and good wishes to you.
Thanks for the reply.
I have a few questions that come from my understanding of the problem.
1. Will my metamorphopsia & floaters dissappear as the vitreous gel will be removed and won't be pulling the retina any more?
2. Is there a case that my IOL will need to be changed as the retina will move back on the posterior staphyloma , extending the distance the image is getting projected? hopefully this will eliminate the need for reading glasses as i now have a myopia of -0.25 dioptres after the cataract surgery?
I have a few questions that come from my understanding of the problem.
1. Will my metamorphopsia & floaters dissappear as the vitreous gel will be removed and won't be pulling the retina any more?
2. Is there a case that my IOL will need to be changed as the retina will move back on the posterior staphyloma , extending the distance the image is getting projected? hopefully this will eliminate the need for reading glasses as i now have a myopia of -0.25 dioptres after the cataract surgery?
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