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(Myopic Traction Maculopathy (Retrospective, consecutive case series …

- - - - vitreomacular traction
      - retinal thickening
      - Macular retinoschisis
      - lamellar macular hole (lamellar MH)
      - foveal retinal detachment (RD)
      - 8% to 34% of people diagnosed with pathologic myopia
    - - Extensive schisis-like thickening in the outer retina
        of highly myopic eyes with posterior staphyloma
        
        inner retinal ﬂuid
        
        Foveal detachment
        
        lamellar or full-thickness macular hole.
      - always occurs within a posterior
        staphyloma.
    - - S0 Absent
      - S1 Extrafoveal
      - S2 Foveal only
      - S3 Foveal but not entire macula
      - S4 Entire macula
    - - Improved
        
        Decreased height or extent of macular retinoschisis
        
        Complete resolution of macular retinoschisis
      - Stable
      - Progressed
        
        Increased height or extent of macular retinoschisis
        
        Development of inner lamellar MH
        
        Development of FTMH
        
        Development of foveal RD
    - - Progression
        
        Progression rate
        
        8.9% of the S2 eyes
        
        13.0% of the S3 eyes
        
        Link Title :fountain_pen:
        
        42.9% of the S4 eyes
        
        Significantly greater risk for [progression]
        
        Not stable
        
        Link Title
        
        1 more item...
        
        3.6% of the S1 eyes
        
        6.3% of the S0 eyes,
        
        Risk Factor
        
        Axial length
        
        macular chorioretinal atrophy
        
        VMT resulting from a perifoveal PVD
        
        intrinsic noncompliance of the ILM
      - Spontaneous resolution
        
        Even eyes classiﬁed as S4
        
        Release in the retinal traction:
        
        PVD in 4 eyes
        
        Spontaneous disruption of the ILM in 2 eyes
        
        Young patients
        
        partial PVD
        
        spontaneous resolution can be expected
        after a complete PVD develops
        
        Older patients
        
        macular retinoschisis is extensive
        
        posterior hyaloid is attached widely
        in the macula area
    - - Follow-up
        
        ILM is disrupted at the initial visit
        
        Macular retinoschisis alone
        without foveal RD or MHRD.
      - Indication of vitrectomy
        
        Progression in OCT
        
        decrease in BCVA
  - - - Tractional factors
        
        relative tautness or noncompliance
        
        the inner retina
        
        vs the outer retina
        
        within the concavity of a posterior staphyloma.
        
        Four major traction mechanisms
        
        Vitreomacular traction (from perifoveal PVD)
        
        Remnant cortical vitreous layer (after PVD)
        
        Epiretinal membrane
        
        Intrinsic noncompliance of the ILM.
        
        rendering it taut like a drum. If you envision a posterior
        
        staphyloma, the ILM is like the surface of a drum and is relatively resistant to permanent deformation and stretching.
        
        microscopic cellular and collagen proliferation
        develops on the ILM after PVD
        
        Retinal arteriolar stiffness (minor mechanism).
      - Nontractional factors related to high myopia
        
        decreased pumping capacity of the RPE
        
        alterations of retinal cell adhesion properties
        
        unlikely to be necessary or sufﬁcient
        to cause myopic traction maculopathy
  - - - 20/40 eye
        
        Not eager to take you to surgery and risk
        losing your reading ability if things do not go perfectly.
    - - intravitreal gas
        
        macular hole,
        
        foveal detachment
      - the need for ILM removal
        
        biomechanical rigidity of the ILM increases with age
        
        ILM peeling increases retinal compliance by 53.6%