Diameter of cystoid spaces and choroidal hypertransmission as novel prognostic biomarkers in myopic foveoschisis

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.