A common surgery for an uncommon problem: vitrectomy with membrane peeling in myopic traction maculopathy

To evaluate vitrectomy with membrane peeling across the spectrum of myopic traction maculopathy (MTM) and identify prognostic factors for anatomical and functional success.

Patients with MTM who underwent vitrectomy and membrane peeling between 2018 and 2023 were included. Percentage reduction in mean foveal thickness (MFT) was used as a marker of anatomical outcome, and visual acuity was the primary outcome. The secondary outcomes were factors associated with anatomical success and visual acuity (VA) improvement.

Ninety-four eyes from 84 patients were included. For myopic foveoschisis-only (37 eyes), the anatomical success rate was 95% with a mean of an 8-letter gain. For isolated macular detachment (without macular holes) (15 eyes), 93% achieved retinal reattachment with a mean of a 3.5-line gain. Isolated macular holes (22 eyes) achieved macular hole closure in 73% of cases with a mean of a 7-letter gain. Macular hole retinal detachment (20 eyes) achieved retinal reattachment in 80% of cases and simultaneous macular hole closure in 20%, with a mean of 3-letter gain. Higher preoperative MFT (p < 0.001) and more advanced perpendicular staging (p < 0.001) were associated with greater % MFT reduction. Better preoperative VA (p < 0.001), less advanced tangential staging (p = 0.016), and preoperative phakic status (p = 0.004) were predictive of better postoperative VA. For myopic foveschisis-only, the use of long-acting gas was associated with a postoperative VA that was 3 lines worse (p = 0.04).

Vitrectomy with membrane peeling is effective in the management of MTM, especially for myopic foveoschisis-only and isolated macular detachment. Less advanced tangential stages and better preoperative VA are predictive of better postoperative VA.