Comparison of facedown and non-facedown positions after vitrectomy with fovea-sparing internal limiting membrane peeling and air tamponade for treating myopic foveoschisis with foveal detachment: A prospective, randomized interventional study

To compare the anatomical and visual outcomes after vitrectomy with facedown (FD) or non-FD positions for treating myopic foveoschisis (MF) with foveal detachment. Prospective, randomized interventional study. 55 eyes with MF and foveal detachment that underwent vitrectomy with fovea-sparing internal limiting membrane (ILM) peeling and air tamponade were randomized to either the postoperative FD (26 eyes) or non-FD (29 eyes) positions. Best-corrected visual acuity (BCVA) and optical coherence tomography were assessed at baseline, 2 weeks, 3 months, and 6 months after vitrectomy with fovea-sparing ILM peeling and air tamponade with the FD or non-FD positions. Logistic and linear regression analyses were performed to study correlations between clinical factors and foveoschisis resolution and postoperative BCVA. All patients completed ≥6 months of follow-up. MF and foveal detachment were completely resolved in 22 eyes (92%) in the FD group and 22 eyes (76%) in the non-FD group (P = 0.160). Macular hole-associated retinal detachment occurred in one eye in the FD (4%) and non-FD (3%) groups. The postoperative best-corrected visual acuity (BCVA) at 6 months did not differ significantly between the two groups (P = 0.495). The BCVA improved by ≥0.3 logMAR in 14 eyes (58%) in the FD group versus 17 eyes (59%) in the non-FD group (P = 0.983). Central foveal thickness (CFT) and height of foveal detachment were significantly associated with foveoschisis resolution (P = 0.045 and 0.039, respectively). Better preoperative BCVA and foveoschisis resolution were significantly associated with better postoperative BCVA (P = 0.031 and 0.003, respectively). The non-FD position appeared to be as effective as the FD position after vitrectomy with fovea-sparing ILM peeling and air tamponade for treating MF with foveal detachment.