Macular buckle technique in myopic traction maculopathy: a 16-year review of the literature and a comparison with vitreous surgery

To determine the natural evolution and surgical indications of myopic foveoschisis (MF), which are still poorly documented, and the factors that predict poor prognosis. Retrospective observational case series. Twenty-nine operated and nonoperated cases of MF (29 eyes of 23 patients) were studied. All eyes underwent repeated examinations, including optical coherence tomographic (OCT) recordings, during a mean follow-up of 31.2 months. Special attention was paid to the evolution of visual acuity (VA) and to the thickness of foveoschisis. Mean refraction was -14.4 diopters, and mean axial length was 29.1 mm. OCT scans revealed that the foveoschisis was associated with macular anomalies: a premacular structure in 13 (44.8%) of 29 eyes, a foveal detachment in 10 (34.5%) of 29 eyes, and a lamellar macular hole in six (20.7%) of 29 eyes. Isolated foveoschisis was found in four eyes (13.8%). During follow-up, foveoschisis and VA worsened in 20 eyes and remained stable in nine. Ten of the 20 eyes that worsened had a premacular structure. A macular hole occurred in nine eyes, six of which had previously exhibited foveal detachment. Eleven eyes with foveoschisis underwent surgery, which improved VA significantly (P = .04, Wilcoxon test), but three eyes developed a macular hole. MF may remain stable for many years without affecting VA. However, when it is combined with the presence of a premacular structure, the risk of a decrease in VA increases. When it is combined with foveal detachment, a macular hole seems to develop frequently, whether or not surgery is performed.

To describe the features and incidence of epiretinal traction and related retinal damage in degenerative myopia. Consecutive observational case series. We retrospectively reviewed medical records and optical coherence tomography findings of 218 eyes with high myopia of 121 consecutive patients to detect the incidence and features of epiretinal traction-related macular damage. The degree of myopia ranged from -8 to -26 spherical equivalent (mean +/- SD, -16.93 +/- 5.74). Mean +/- SD axial length was 29.75 +/- 2.12 mm. Excluding eyes with possibly confounding features, 125 eyes were analyzed. Detection of epiretinal traction and related macular damage. Epiretinal traction was found in 58 (46.4%) of 125 eyes and retinal damage, in 43 eyes (34.4%). Macular retinoschisis was the most frequent form of macular damage (25 eyes [58%]), followed by retinal thickening, lamellar hole, and shallow retinal detachment. Epiretinal traction is a frequent finding in degenerative myopia and, particularly if associated with the presence of staphyloma, can generate a form of macular damage unique to eyes with high myopia. This damage can affect up to one third of these eyes and should be considered as a separate cause of visual loss easily detected by optical coherence tomography at its early stages.

To investigate the effectiveness and safety of a new surgical technique of fovea-sparing internal limiting membrane (ILM) peeling for the treatment of foveal retinal detachments (RDs) in eyes with myopic traction maculopathy.