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Myopic traction maculopathy in fovea-involved myopic chorioretinal atrophy

Eye volume 38, pages 3586–3594 (2024)Cite this article

Subjects

Abstract

Objectives

To assess the specific features of myopic traction maculopathy (MTM) in the context of myopic macular atrophy (MA). The evolution, surgical considerations, optimal surgical procedures, and results were studied.

Methods

Retrospective, consecutive cases collection was performed for highly myopic eyes with MA (category 4, the classification system of META-analysis for Pathologic Myopia). Eighty-seven eyes of 75 patients with MA were included. The characteristics and evolution of the MTM were analyzed. Surgical indications and outcomes were evaluated and specific surgical features and techniques were assessed.

Results

Approximately half (50.6%) of the cases with MA presented with various stages of MTM. The majority were maculoschisis with a lamellar macular hole (LMH) and were characterized by an O-shaped LMH, high outer retinal schisis, thin floor, and a high percentage of thickened epiretinal tissue. Half (50%) of them either displayed maculoschisis progression (61%) or developed into macular hole with retinal detachment (39%), and all received surgical intervention. The inverted ILM flap technique, with or without fovea-sparing ILM peeling, was the most frequently used surgical technique (78%). Complete traction relief was achieved in most cases (94%).

Conclusion

MA contributes to the specific configuration and evolution of MTM, and characteristic maculoschisis with LMH is a frequent presentation in MA patients. MHRD development and structural progression were two major reasons for surgical intervention. Vitrectomy with inverted ILM flap effectively stabilized the macular structure with few recurrences.

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Fig. 1: The demonstration of macular atrophy with single patch and multifocal patches, measurement of area percentage of macular atrophy, and three types of lamellar macular hole.
Fig. 2: Illustration of the surgical technique for maculoschisis with macular atrophy and lamellar macular hole, alongside a case example of a patient who underwent surgical intervention.
Fig. 3: Typical maculoschisis with macular atrophy and lamellar macular hole, with serial optical coherence tomography images demonstrating the development and progression of an O-shaped lamellar macular hole, structural worsening, and retinal detachment in myopic traction maculopathy.

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Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, National Taiwan University Hospital Hsin-Chu Hospital, Hsinchu City, Taiwan

    Cheng-Yung Lee

  2. Department of Ophthalmology, National Taiwan University Hospital, Taipei City, Taiwan

    Cheng-Yung Lee, Tso-Ting Lai, Ta-Ching Chen, Yi-Ting Hsieh, Tzyy-Chang Ho, Chang-Hao Yang & Chung-May Yang

  3. Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan

    Cheng-Yung Lee & Tso-Ting Lai

  4. Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei City, Taiwan

    Tso-Ting Lai, Ta-Ching Chen, Yi-Ting Hsieh, Tzyy-Chang Ho, Chang-Hao Yang & Chung-May Yang

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Contributions

CYL conducted data curation, formal analysis, investigation, and figure production, wrote the original draft, and contributed to manuscript revision and editing. TTL, TCC, and YTH were involved in conceptualization, provided resources, contributed to methodology development, and offered feedback on the manuscript. TCH participated in conceptualization, provided resources, assisted with methodology development, guided the discussion, and offered feedback. CHY provided resources, assisted with methodology development, and commented on the manuscript. CMY contributed to conceptualization, supervised the investigation, validated the methodology and final results, provided resources, and reviewed, revised, edited, and approved the manuscript.

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Correspondence to Chung-May Yang.

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Lee, CY., Lai, TT., Chen, TC. et al. Myopic traction maculopathy in fovea-involved myopic chorioretinal atrophy. Eye 38, 3586–3594 (2024). https://doi.org/10.1038/s41433-024-03366-w

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