Inter-Eye Comparison in Highly Myopic Patients with Unilateral Myopic Traction Maculopathy

Purpose: To describe a comprehensive OCT-based classification of myopic traction maculopathy (MTM). Methods: Two hundred eighty-one eyes with MTM (visited from 2006 to 2018), were retrospectively reviewed for age, best-corrected-visual-acuity (BCVA), axial length (AL), optical coherence tomography (OCT), and wide-field color fundus-photographs. The study was divided in two Phases. Phase 1: MTM types were categorized with OCT and correlated with age and BCVA. The type of staphyloma was described. Phase 2: the evolution of MTM was studied evaluating at least three OCT exams of each eye taken at different timings (interval between each exam: 1–10 years). Results: Phase 1: We identified, four MTM retinal stages (1. Inner/Outer Maculoschisis; 2. Predominantly outer Maculoschisis; 3. Maculoschisis-Macular Detachment; 4. Macular Detachment) and three foveal stages (a. Normal fovea; b. Inner Lamellar-Macular-Hole; c. Full-Thickness-Macular-Hole). Outer-Lamellar-Macular-Holes and epiretinal abnormalities were associated findings. Stages 1 to 2 were younger than stages 3 to 4 ( p < 0.05). BCVA in stages 1, 2 was similar, and higher than stages 3, 4 ( p < 0.02). About 14% of eyes had no staphyloma, 73% of eyes had staphyloma type 1 or 2. MTM stages were not correlated with AL. Phase 2: The retina could change in time from stage 1 to 4, or the fovea could change from stage a to c. Mean evolution time from stage 1 to 2, stage 2 to 3, and 3 to 4 were 20, 12, 3 months, respectively. BCVA decreased over time as stages increased ( p = 0.47). Conclusion: The MSS Table displays a new classification, the natural evolution, and practical insights for the management of MTM.

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Proposal for the management of myopic traction maculopathy based on the new MTM staging system

European Journal of Ophthalmology ◽

10.1177/1120672120980943 ◽

2020 ◽

pp. 112067212098094

Author(s):

Barbara Parolini ◽

Michele Palmieri ◽

Alessandro Finzi ◽

Rino Frisina

Keyword(s):

Retrospective Review ◽

Surgical Complications ◽

Pars Plana Vitrectomy ◽

Staging System ◽

Combined Surgery ◽

Primary Surgery ◽

Myopic Traction Maculopathy ◽

Pars Plana ◽

Phakic Eyes

Purpose: To propose the Myopic Traction Maculopathy (MTM) management Table, based on the MTM Staging System (MSS). Methods: A retrospective review of 157 eyes affected by MTM, operated with pars plana vitrectomy (PPV), or macular buckle (MB) or combined surgery (MB + PPV). Each case was classified according to the MSS. Anatomical results were evaluated with OCT at an intermediate follow-up (3–6 months) and at a final follow-up (2–8 years), considering changes both in the foveal and in the retinal pattern. The number and type of operations needed were noted. The surgical complications were reported. Results: Primary surgery was MB for 83 eyes (52%), PPV for 36 (23%) and MB + PPV for 38 (24%). At intermediate follow-up, the retinal pattern was restored in 55.41% and foveal in 42.68%. Further surgery was indicated as PPV in 25.48%, MB in 14.65%. At the final follow-up, the retinal pattern was restored in 96.16% and the foveal pattern in 87.90%. BCVA improved at the final follow-up ( p < 0.05). The complications of MB were not sight-threatening. The complications of PPV were FTMH in 67% cases in stages 2, 3, and 4. Cataract developed in 60% of phakic eyes. The complications of combined MB+PPV were cataract (56%) and PVR (5%). Conclusions: Both PPV and MB may be used to treat MTM. PPV addresses the changes in the foveal pattern while MB addresses the changes in the retinal pattern. The MTM management table offers a proposal for the choice of type and timing of treatment customized per each stage of MTM.

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Vitrectomy with fovea-sparing ILM peeling versus total ILM peeling for myopic traction maculopathy: A meta-analysis

European Journal of Ophthalmology ◽

10.1177/1120672120970111 ◽

2020 ◽

pp. 112067212097011

Author(s):

Jingye Wu ◽

Qian Xu ◽

Jie Luan

Keyword(s):

Meta Analysis ◽

Statistical Significance ◽

Secondary Outcome ◽

Ilm Peeling ◽

Foveal Thickness ◽

Outcome Parameters ◽

Standard Mean Difference ◽

Surgical Methods ◽

Myopic Traction Maculopathy ◽

Anatomic Success

Purpose: To evaluate the effect and safety of fovea-sparing internal limiting membrane (ILM) peeling (FSIP) for myopic traction maculopathy comparing with that of total ILM peeling (TP). Methods: PubMed, Web of science, Embase, Cochrane, EBSCO and CNKI, published until January 2020, were searched. Postoperative best-corrected visual acuity (BCVA), postoperative central foveal thickness (CFT), the rate of visual improvement and anatomic success were the main outcome parameters, and the secondary outcome parameters were postoperative complications. Random-effects models were chosen in regard with multi-studies. Standard mean difference (SMD) with 95% confidence interval (CI) and odds ratio (OR) were applied as effect sizes of continuous and binomial data, respectively. Results: Six comparative studies involving 193 eyes were included. Better postoperative BCVA was detected in the FSIP group (SMD = −0.39, 95%CI: −0.69 to −0.09, p = 0.01). The FSIP group had a higher rate of vision improvement with statistical significance (OR = 3.86, 95%CI: 1.36 to 10.97, p = 0.01). Both surgical methods had similar outcomes for postoperative CFT (SMD = 0.07, 95%CI: −0.27 to 0.40, p = 0.70). The FSIP group had a higher rate of anatomic success, though there was no obvious significance (OR = 2.54, 95%CI: 0.96 to 6.74, p = 0.06). For the development of postoperative full-thickness macular hole (FTMH), the rate was lower in the FSIP group (OR = 0.18, 95%CI: 0.05 to 0.64, p = 0.008). Conclusion: Vitrectomy with fovea-sparing ILM peeling for myopic traction maculopathy could gain better visual outcomes and decrease incidence of FTMH development, though there was no obvious difference in postoperative CFT and the rate of anatomic success between two groups.

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SURGICAL OUTCOMES OF MYOPIC TRACTION MACULOPATHY ACCORDING TO THE INTERNATIONAL PHOTOGRAPHIC CLASSIFICATION FOR MYOPIC MACULOPATHY

Retina ◽

10.1097/iae.0000000000002642 ◽

2019 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kyung Sik Lee ◽

Jihei Sara Lee ◽

Hyoung Jun Koh

Keyword(s):

Surgical Outcomes ◽

Myopic Traction Maculopathy ◽

Myopic Maculopathy

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Vitrectomy and scleral imbrication in patients with myopic traction maculopathy and macular hole retinal detachment

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-016-3523-7 ◽

2016 ◽

Vol 255 (4) ◽

pp. 673-680 ◽

Cited By ~ 8

Author(s):

Yoshimasa Ando ◽

Akito Hirakata ◽

Arisa Ohara ◽

Reiji Yokota ◽

Tadashi Orihara ◽

...

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Macular Hole Retinal Detachment ◽

Myopic Traction Maculopathy

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Long-Term Follow-Up of the Fellow Eye in Patients Undergoing Surgery on One Eye for Treating Myopic Traction Maculopathy

Journal of Ophthalmology ◽

10.1155/2016/2989086 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Hui-Juan Xia ◽

Wei-Jun Wang ◽

Feng’E Chen ◽

Ying Wu ◽

Zhen-Yuan Cai ◽

...

Keyword(s):

Axial Length ◽

Initial Examination ◽

Fellow Eye ◽

Posterior Staphyloma ◽

Chorioretinal Atrophy ◽

Myopic Traction Maculopathy ◽

Potential Risk Factors ◽

The Difference ◽

Fellow Eyes

Objective. To observe the fellow eye in patients undergoing surgery on one eye for treating myopic traction maculopathy.Methods. 99 fellow eyes of consecutive patients who underwent unilateral surgery to treat MTM were retrospectively evaluated. All patients underwent thorough ophthalmologic examinations, including age, gender, duration of follow-up, refraction, axial length, intraocular pressure, lens status, presence/absence of a staphyloma, and best-corrected visual acuity (BCVA). Fundus photographs and SD-OCT images were obtained. When feasible, MP-1 microperimetry was performed to evaluate macular sensitivity and fixation stability.Results. At an average follow-up time of 24.7 months, 7% fellow eyes exhibited partial or complete MTM resolution, 68% stabilized, and 25% exhibited progression of MTM. Of the 38 eyes with “normal” macular structure on initial examination, 11% exhibited disease progression. The difference in progression rates in Groups 2, 3, and 4 was statistically significant. Refraction, axial length, the frequency of a posterior staphyloma, chorioretinal atrophy, initial BCVA, final BCVA, and retinal sensitivity all differed significantly among Groups 1–4.Conclusions. Long axial length, chorioretinal atrophy, a posterior staphyloma, and anterior traction contribute to MTM development. Patients with high myopia and unilateral MTM require regular OCT monitoring of the fellow eye to assess progression to myopic pre-MTM. For cases exhibiting one or more potential risk factors, early surgical intervention may maximize the visual outcomes.

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