<p>Myopic Traction Maculopathy: Diagnostic and Management Strategies</p>

Abstract

Pathologic myopia (PM) is an ocular disorder characterized by a spherical equivalent (SE) of more than – 6.0 diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM is associated with myopic maculopathy (MM). The ATN classification describes all the aspects of MM which regroups atrophic, tractional and neovascular consequences to the sclera, choroid and retina of highly myopic eyes. The advent of OCT allowed to define the ultrastructural characteristics of the tractional changes in MM, described by the term myopic traction maculopathy (MTM). They include foveoschisis/maculoschisis/retinoschisis (FS/MS/RS), retinal/foveal detachment (RD/FD), lamellar macular holes (LMH) and full-thickness macular holes (FTMH) with or without RD (MHRD). The MTM staging system (MSS) describes all foveal and retinal changes related to MTM and their natural history interpreting them as different stages of a single progressive disorder. The management of MTM can be just observation for the earliest cases with good vision or surgery for the severe stages with vision loss. There are two possible surgical approaches: ab externo, that acts on the alteration of the scleral shape and includes posterior scleral reinforcement and macular buckle. Ab interno, that targets the alteration of the foveal profile and consists in pars plana vitrectomy with removal of all the epiretinal tractions, maneuvers on the internal limiting membrane, and the use of intravitreal tamponade and laser. As they target two different sides of the same pathology, the two techniques have to be selected on the base of the MTM stage, single or combined.

Relationship between Axial Length and Levels of TGF-β in the Aqueous Humor and Plasma of Myopic Patients

“…Hence, its prevention is an important global issue [ 1 ]. Myopia involves scleral remodeling and excessive axial length (AL) elongation [ 2 ], which can lead to posterior staphyloma, choroidal neovascularization, and tractional maculopathy [ 3 ]. This can result in pathologic myopia complications such as glaucoma, retinal detachment, chorioretinal atrophy, and macular hole, which can lead to impaired vision and even blindness [ 4 ].…”

Long-term surgical outcomes and prognostic factors of foveal detachment in pathologic myopia: based on the ATN classification

“…However, clinical intervention for MTM is complex and still controversial. According to the natural course of MTM, myopic macular retinoschisis appears first at the early stage, and in severe cases, will evolve to FD and cause vision loss [ 14 ]. However, considering the variable natural prognosis of myopic retinoschisis, using surgical approaches for all retinoschisis may not be the optimal choice for MTM management.…”

Impact of lens opacity and axial length on concomitant screening of maculopathy by swept-source optical coherence tomography-based optical biometer

“…Retinoschisis is a myopic traction maculopathy. Patients with retinoschisis might have a long axial length, leading to poor foveal image quality and a low detection rate ( 24 ). Epiretinal membrane stage 1 is difficult to detect with SS-OCT, as the foveal pit and retinal layers remain well defined ( 14 ).…”