Long-term surgical outcomes of myopic traction maculopathy eyes treated outside of the MTM staging system guidelines

Abstract

Purpose: To evaluate the long-term surgical outcomes of pars plana vitrectomy (PPV) in managing myopic traction maculopathy (MTM), particularly in cases where macular buckle (MB) was the recommended intervention based on the MTM staging system (MSS), and to assess the feasibility of PPV in resource-limited settings. Methods: This retrospective study analyzed 48 eyes from 36 patients diagnosed with MTM on spectral-domain optical coherence tomography (OCT), managed by a single vitreoretinal surgeon. Inclusion criteria required high-quality OCT imaging and a minimum follow-up of 12 months. MTM staging was performed using the MSS, and treatments were categorized as concordant or divergent from MSS recommendations. Demographic, clinical, and surgical details, including visual acuity and OCT changes, were documented. Statistical analysis assessed the functional and anatomical outcomes in cases treated outside the MSS guidelines. Results: Among 48 eyes, 27 (56%) underwent PPV, with 96% (n = 26) treated divergently from MSS recommendations. The median follow-up was 72 months. Significant improvement in visual acuity was observed postoperatively (preoperative: 1.00 logMAR, postoperative: 0.69 logMAR; P = 0.043). OCT imaging showed resolution of maculoschisis and foveal neurosensory detachment in most cases (P < 0.05). However, 19% of eyes required second intervention due to primary surgical failure. Conclusion: PPV achieved significant functional and anatomical improvements in MTM management, even in cases where MB was recommended. However, an approximate 20% surgical failure rate underscores its limitations. These findings highlight the need for improved access to MB and specialized training to optimize MTM management, particularly in resource-constrained settings.