Ring-Peeling: A Novel Fovea-sparing Internal Limiting Membrane Peeling Technique for Myopic Foveoschisis with Foveal Detachment

Purpose: To introduce a novel fovea-sparing internal limiting membrane (ILM) “Ring-peeling” technique and evaluate its effectiveness for treating myopic foveoschisis (MFS) with foveal detachment via pars plana vitrectomy (PPV). Methods: This technique was applied to 12 eyes (11 patients). During PPV, a 1-disc diameter (DD)-wide ILM flap was created, with its inner edge at least ¼ DD from the foveola. The flap was peeled tangentially toward the fovea and parallel to the inner retinal curvature. When the flap narrowed to half its original width, it was centrifugally extended. Intraoperative ILM peeling performance, postoperative anatomical and visual outcomes were measured. Results: During PPV, an ILM shield was preserved on the fovea in all eyes. In 10 eyes (83.3%), ILM peeling was continuous and based on a single ILM flap. After a follow-up of 20.2 ± 7.1 months, schisis cavities resolved and the fovea reattached in all eyes. The external limiting membrane was retrieved in 9 eyes (75%). BCVA improved in all eyes compared to preoperative levels, with 3 eyes achieving a BCVA above 20/50. Conclusion: This technique enhances the certainty of preserving an ILM shield on the fovea and achieves good postoperative visual and anatomical outcomes.