Myopic Traction MaculopathyTommaso Rossi MD

History 1999 Takano and Kishi identify Myopic Schisis without MH

2004 Panozzo and Mercanti use the term Myopic Traction Maculopathy

2007 Panozzo and Mercanti suggested “Retinoschisis” to be used for irreversible damage only

Definition Macular retinoschisis often limited to the stapyloma with epiretinal traction, no holes and often accompanied

by shallow retinal detachment

Tommaso Rossi MD ®

Myopic FoveoSchisis Vs Traction Syndrome

Takano M, Kishi S. Foveal retinoschisis and retinal detachment in severely myopic eyes with posterior staphyloma. Am J Ophthalmol. 1999;128(4):472–476

Panozzo G, Mercanti A. Vitrectomy for myopic traction maculopathy. Arch Ophthalmol. 2007;125(6):767–772

Panozzo G, Mercanti A. Optical coherence tomography findings in myopic traction maculopathy. Arch Ophthalmol. 2004;122(10):1455–1460

Anatomy Isolated Foveal Thickening with Schisis (13%)

Associated to Foveal Detachment (34%)

Lamellar Macular Hole (20%)

Epiretinal Membrane (44%)

Symptoms Affected Vision Vs Non-affected Vision (Gaucher)

May be Asymmptomatic for long time

Visual Loss

Metamorphopsia

Tommaso Rossi MD ®

Clinical Features

Gaucher D, Haouchine B, Tadayoni R, Massin P, Erginay A, Benhamou N, Gaudric A. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome. Am J Ophthalmol. 2007;143:455–462. doi: 10.1016

Evolution ERM presence increases the risk of visual loss

20/29 (68%) worsened visually

9/29 (31%) developed a macular hole

Average follow up 31 months

Tommaso Rossi MD ®

Prognosis

Gaucher D, Haouchine B, Tadayoni R, Massin P, Erginay A, Benhamou N, Gaudric A. Long-term follow-up of high myopic foveoschisis: natural course and surgical outcome. Am J Ophthalmol. 2007;143:455–462. doi: 10.1016

Eye (Lond). 2009 Feb;23(2):356-61. Epub 2007 Dec 7. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia. Wu PC1, Chen YJ, Chen YH, Chen CH, Shin SJ, Tsai CL, Kuo HK

Prognosis (124 eyes)

ERM, axial length >31mm and chorioretinal atrophy are independent risk factors for MH development

Tommaso Rossi MD ®

EvolutionRare Sponaeous Resolution 207 eyes, 24 months minimum follow-up, mean FU 36 months

3.9% complete resolution

11.6% Progression of MTM

Am J Ophthalmol. 2013 Nov;156(5):948-957.e1. doi: 10.1016/j.ajo.2013.06.031. Epub 2013 Aug 20. Natural course of myopic traction maculopathy and factors associated with progression or resolution. Shimada N1, Tanaka Y, Tokoro T, Ohno-Matsui K

Prognostic Factors Better Pre-op BCVA

Shorter axial lenght

Absence of Foveolar Detachment

Retina. 2010 Jun;30(6):874-80. Factors correlated with postoperative visual acuity after vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Kumagai K1, Furukawa M, Ogino N, Larson E

Lamellar/Full Thickness MH Retinal loss of Tissue

Tommaso Rossi MD ®

Evolution

Dehiscence of detached internal limiting membrane in eyes with myopic traction maculopathy with spontaneous resolution. Hirota K, Hirakata A, Inoue M. BMC Ophthalmol. 2014 Mar 29;14:39. doi: 10.1186/1471-2415-14-39

Rare Sponaeous Resolution Vitreous Adhesion Resolution

Foveolar Detachment Within the staphyloma

Observation Vs Surgery: Timing ? Optimal Surgical Timing is currently unknown

Lamellar MH

ERM presence

Foveolar detachment

Visual loss

Metamorphopsia

Retinal sensitivity (MP1 Microperimetry)

Ratiglia R, Osnaghi S, Bindella A, Pirondini C. Posterior traction retinal detachment in highly myopic eyes: clinical features and surgical outcome as evaluated by optical coherence tomography. Retina. 2005;25(4):473–478

Futagami S, Inoue M, Hirakata A. Removal of internal limiting membrane for recurrent myopic traction maculopathy. Clin Experiment Ophthalmol. 2008;36(8):782–785.

Tommaso Rossi MD ®

Surgical Indication

Vitrectomy ± ILM Peel 71 eyes

ILM peeling correlated with increased BCVA

ERM recurrence more often with no ILM peel

Tommaso Rossi MD ®

Surgical Technique

Vitrectomy with or without internal limiting membrane peeling for each stage of myopic traction maculopathy. Taniuchi S, Hirakata A, Itoh Y, Hirota K, Inoue M. Retina. 2013 Nov-Dec;33(10):2018-25

Vitrectomy + ILM Peel 509 eyes

ILM peeling correlated with increased BCVA

ERM recurrence more often with no ILM peel

Epiretinal membrane surgery outcomes in highly myopic eyes without traction maculopathy: long-term results of a case-control study. El Sanharawi M, Sandali O, Bonnel S, Laroche L, Monin C. Am J Ophthalmol. 2013 Aug;156(2):319-325

Vitrectomy + ILM peel 41 eyes, 6 months follow-up

Mean post-op VA 20/70 (20/130 pre-op)

Foveal Thickness 265 micron (558 pre-op)

Eyes with foveal detachment and/or MH improved more than those with MTM alone

Tommaso Rossi MD ®

Surgical Technique

Vitrectomy + ILM peel 17 eyes, 6 months FU. PPV + ILM peel + C3F8 or BSS

C3F8 receiving eyes improved more rapidly than BSS receiving eyes

Retina. 2011 Apr;31(4):692-701. Vitrectomy and internal limiting membrane peeling with perfluoropropane tamponade or balanced saline solution for myopic foveoschisis. Zheng B1, Chen Y, Chen Y, Zhao Z, Zhang Z, Zheng J, You Y, Wang Q, Shen L

Macular Episcleral Buckling + Vitrectomy 16 eyes

Anatomical success 100%

Improved vision 85% (13/16)

Tommaso Rossi MD ®

Surgical Technique

Dev Ophthalmol. 2014;54:135-46. doi: 10.1159/000360459. Epub 2014 Aug 26. Suprachoroidal buckling. El Rayes EN1.

Supra-Choroidal Buckling 24 eyes. Long-lasting hyaluronic acid

83% resolution of MH associated detachment

66% improvement of Visual AcuityRetina. 2014 Jan;34(1):129-35. doi: 10.1097/IAE.0b013e31828fcb77. Supra choroidal buckling in managing myopic vitreoretinal interface disorders: 1-year data. El Rayes EN1.

Br J Ophthalmol. 2014 Jan;98(1):104-9. doi: 10.1136/bjophthalmol-2013-304016. Epub 2013 Oct 29. Visual and anatomical outcome after macular buckling for macular hole with associated foveoschisis in highly myopic eyes. Burés-Jelstrup A1, Alkabes M, Gómez-Resa M, Rios J, Corcóstegui B, Mateo C.

Foveolar ILM NON-Peeling technique 45 eyes. 30 Foveolar NON-ILM peel; 15 total ILM peel

MH developed in 16% of total peel and none Non-foveolar peel

Inner/Outer Segment line recovered in 75% Non-Foveolar and 15% Total Peel

Tommaso Rossi MD ®

Surgical Technique

Retina. 2014 Sep;34(9):1833-40. Long-term outcome of foveolar internal limiting membrane nonpeeling for myopic traction maculopathy. Ho TC1, Yang CM, Huang JS, Yang CH, Yeh PT, Chen TC, Ho A, Chen MS

Am J Ophthalmol. 2012 Oct;154(4):693-701. doi: 10.1016/j.ajo.2012.04.013. Epub 2012 Jul 25. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Shimada N1, Sugamoto Y, Ogawa M, Takase H, Ohno-Matsui K.

Vitreo-macular Adhesion Pharmacological Lysis (?) Ocriplasmin indication relates to “focal” adhesion (<1500 micron)

Tommaso Rossi MD ®

(Para-) Surgical Technique (?)

Clin Ophthalmol. 2011;5:1151-65. doi: 10.2147/OPTH.S14840. Epub 2011 Aug 18. Emerging nonsurgical methods for the treatment of vitreomacular adhesion: a review. Schneider EW1, Johnson MW

Thank YouTommaso Rossi MD ®