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

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