Myopic traction maculopa (MTM) and macular hole retinal detachments (MHRDs) are complex scenarios that demand accurate diagnoses and high surgical expertise. Internal limiting membrane (ILM) peeling and foveal-sparing ILM flap techniques are showing improved macular hole closure rates in difficult cases.
These pathologies fall into four categories, each of which requires a different treatment approach, according to Hiroko Terasaki, MD.
The first three categories-schisis only, schisis and retinal detachment, and full-thickness macular hole (FTMH)-are the prodromal stages of MHRDs, the fourth category, said Dr. Terasaki, who is chairman and professor, Department of Ophthalmology, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
Simple schisis and schisis and retinal detachment
In eyes with schisis without a foveal detachment-i.e., schisis only-total ILM peeling is performed. At first, the posterior vitreous membrane and residual vitreous cortex are removed. Triamcinolone is injected again and the ILM is peeled gently.
"Correct diagnosis is the important factor," said Dr. Terasaki, describing an eye that had more than just simple schisis. Those eyes should be included in the group with foveal retinal detachments, which are seen clearly on swept-source optical coherence tomography (SS-OCT).
When considering these more complicated eyes, previous studies have reported that MHs develop in about 10% of eyes after total ILM peeling.
Interestingly, macular holes have been reported much less often or do not develop after ILM peeling that spared the fovea to treat myopic schisis, Dr. Terasaki noted.
Even in eyes with schisis only, schisis with a deep pseudohole, i.e., schisis shaped like a champagne flute, would be an indication for this method.
Hiroko Terasaki, MD
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This article was adapted from Dr. Terasaki's presentation during Retina Subspecialty Day at the 2017 meeting of the American Academy of Ophthalmology. Dr. Terasaki reported a financial interest in Carl Zeiss Meditec.