Pathological myopia (high myopia-associated chorioretinopathy) is predominantly characterized by posterior scleral staphyloma after axial growth, resulting in traction macular degeneration, retinal detachment and macular hole, etc. At present, vitrectomy yields relatively low success rate, unsatisfied therapeutic effect and poor clinical prognosis. The incidence of postoperative cataract and macular atrophy is also relatively high.
Episcleral pressurization of macula is a novel and effective surgical procedure to prevent axial growth and treat traction macular degeneration caused by posterior scleral staphyloma, which is highly demanding and requires multidisciplinary cooperation. Department of Ophthalmology of the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) intimately cooperated with Zhongshan Ophthalmic Center of Sun Yat-sen University, and successfully completed this surgery in July, 2022, which is the first of its kind in Shaanxi province and northwest China.
Seven patients were scheduled to undergo episcleral pressurization of macula. A 26-year-old patient, Xiaoli (anonymous name), developed blurry and distorted vision in her right eye 4 months ago, and her visual acuity continually declined to 0.4. Ocular examination in our hospital showed that the axial length of the right eye was up to 29 mm. OCT revealed macular splitting complicated with localized retinal detachment in the macular area of the right eye. B-mode ultrasound and MRI showed significant posterior scleral staphyloma of the right eye. She was diagnosed with macular splitting complicated with retinal detachment in the right eye, and high myopia complicated with macular atrophy in the left eye. Considering the specific conditions of this patient, episcleral pressurization of macula (macular buckling) was recommended. After thorough communication, the patient and her families agreed to undergo the surgery.
Department of Ophthalmology of our hospital delivered in-depth discussion with the fundus team from Zhongshan Ophthalmic Center regarding the patient's conditions. After confirming the diagnosis and treatment plan of our hospital, experts from Zhongshan Ophthalmic Center also suggested the patient to receive specific MRI sequencing. Imaging Department performed specific MRI sequencing for this patient, repeatedly synthesized and processed the data and completed 3D modeling of the eyeball. On July 22, 2022, Professor Lyu Lin, Director of Department of Fundus Surgery of Zhongshan Ophthalmic Center and Professor Liu Bingqian’s team came to our hospital and provided guidance for the surgery. Seven patients, including Xiaoli, successfully underwent episcleral pressurization of macula, and the surgery endured for 30 min. At postoperative 1 week, the best corrected visual acuity (BCVA) of the patient's right eye was restored to 0.8, and the symptoms of visual distortion were relieved. The remaining 6 patients were also recovered well, and discharged from hospital within 1 week after surgery.
Department of Ophthalmology of our hospital is one of the first to carry out minimally invasive vitreoretinal surgery (23G, 25G, 27G) with a wide-angle viewing system in Shaanxi province, one of the first-batch affiliations to perform macular hole surgery with inner limiting membrane peeling in northwest China, and the first to complete episcleral pressurization of macula in northwest China, providing better medical services for high myopia patients complicated with macular degeneration.
