Surgical management of myopic traction maculopathy; expert perspectives from the myopia society

Myopic traction maculopathy (MTM) occurs in approximately 9-34 % of highly myopic eyes and requires surgical treatment to prevent irreversible vision loss due to progression to macular hole (MH) or retinal detachment (RD). While treatment of MTM, which presents with a variety of morphological patterns, shares the common goal of managing the causative tractional tissues on the retina, it is essential to tailor the surgical plan according to the locations of each lesion. Here, we classify MTM into four core lesions: retinoschisis, foveal RD, lamellar MH (LMH), and full-thickness MH (FTMH), and present an algorithm for treatment decision-making. Pars plana vitrectomy (PPV) is a procedure that enables reliable removal of traction-inducing tissues and should be promptly indicated for patients with foveal RD showing progressive vision decline or those with MHRD. Postoperatively, development of macular hole or progression of macular atrophy should be monitored carefully. In recurrent MTM, inadequate membrane peeling is a common cause, requiring wide-field imaging and more intensive intraoperative assessment for residual tissues. Recurrent MTM without FTMH is treated with additional ILM peeling, while recurrence with FTMH is managed surgically using techniques involving ILM flaps, autologous retinal flap, or amniotic membrane transplantation. Macular buckling has also been reported to be effective when used alone or in combination with PPV. Following treatment, long-term follow-up is essential for monitoring both recovery and recurrence. Though further validation through randomized prospective trials is needed, the paradigm for MTM surgery continues to evolve toward preventing persistent vision loss and to optimizing long-term outcomes.