Traktive myope Makulopathie – vitreoretinales Traktionssyndrom bei hoher Myopie und hinterem Staphylom

Abstract

The pathology of the posterior pole in high myopic eyes is characterised by scleral thinning and staphyloma associated with structural changes of the retina. Epiretinal membranes and epiretinal traction together with partial separation of the ILM result in myopic foveoschisis and posterior tractional detachment with myopic macular holes. Foveal detachment and retinoschisis in highly myopic eyes may resolve after vitrectomy with ILM peeling: however, there is a considerable risk for the development of macular hole formation. Skleral buckling surgery is currently regaining interest and allows one to reduce the tractional forces in selected cases. While reading visual acuity is usually not regained after macular hole development, prophylactic measures should be considered for the fellow eye. Vitreous surgery might have a rationale as prophylactic treatment for highly myopic eyes at high risk of macular hole development; however, this needs to be weighed against possible surgical complications.

Retinal structural-vascular-functional relationship using optical coherence tomography and optical coherence tomography – angiography in myopia

“…This is explained by the same tractional and tangential forces acting on the inner retina. Similar findings of shallowing of foveal contour with persistent/thickening of IRLs have also been noted in ocular pathologies like retinopathy of prematurity and familial exudative vitreo-retinopathy [41–44]. These diseases are associated with secondary high myopia and the retinal findings could be because of high myopia rather than the primary disease itself.…”

“…We speculate that the retinal changes seen in our study may result from the combined tangential and/or antero-posterior tractional forces acting on the inner retina and tangential stretching force on the outer retina due to the overall myopic globe expansion. A similar mechanism has been described in eyes with myopic tractional maculopathy [41]. However, further longitudinal studies would be required to see whether these eyes progress to develop myopic tractional maculopathy.…”

Surgical treatment of a chronic foveal retinal detachment combined with staphyloma, foveoschisis, and macular hole

“…[ 4 ] The pathogenesis has not yet been clearly established; however, myopic foveoschisis is believed to be caused by strong vitreomacular traction on the fovea and the retinal changes correlated to this traction, poor elasticity of the ILM, inflexibility of the retinal vessels and ERM in association with axial length elongation and stretching of the retina due to a preexistent staphyloma. [ 2 4 5 6 7 8 9 ]…”

<p>Pathogenesis and Prevention of Worsening Axial Elongation in Pathological Myopia</p>

“…The visual prognosis of myopic macular CNV is poor, as patients have visual acuity of 20/200 or worse in 5 years; therefore, ophthalmologists should consider active interventions for early myopic treatment. 92,93,98 Myopic foveoschisis is increasingly prevalent as a visionthreatening complication. It is characterized by the splitting of retinal layers in the macula, which is more frequently seen in myopic eyes of greater than 8 diopters.…”