[Chiba Medical Society Award Review] Quest for treating myopic tractional maculopathy

[ABSTRACT] The population with high myopia is growing worldwide, especially in East Asia. In eyes with pathologic myopia, the axial length is elongated and the eyeball’s shape resembles a rugby ball. The posterior pole of the eye has an outpouching structure, and this unique shape is called a posterior staphyloma. The posterior staphyloma affects the pathogenesis of myopic tractional maculopathy (MTM). MTM is caused by traction on the macula and develops retinal schisis, macular hole, and retinal detachment due to a macular hole. The prevention of advanced stages of MTM, such as retinal detachment, is essential. As the tractional force on the retina is mainly caused by posterior staphyloma and posterior vitreous cortex/internal limiting membrane, two approaches, scleral surgery and vitrectomy, are currently used. Although there have been many surgical options for treating eyes with MTM, the standard approach for this pathology is yet to be established. Less invasive surgery is ideal because myopic schisis is an early stage of MTM in patients with relatively good vision, and secondary macular hole and visual decline are sometimes observed after surgery for myopic schisis. We used scleral imbrication and achieved significant visual recovery with less chance of developing a secondary macular hole.