Long-Term Outcome of Foveolar Internal Limiting Membrane Nonpeeling for Myopic Traction Maculopathy

In Brief Purpose: To investigate the long-term results of a novel technique to preserve the foveolar cone without peeling off the foveolar internal limiting membrane (ILM) during myopic traction maculopathy surgery. Methods: Nineteen patients (19 eyes) were retrospectively studied and divided into 2 groups by the extent of ILM peeled and followed for more than 3 years. Group 1: foveolar ILM nonpeeling group (FN) (12 eyes) and Group 2: total peeling of foveal ILM group (TP) (7 eyes). A donut-shaped ILM was peeled off, leaving a 400-μm diameter ILM over foveola with a sharp margin in FN group. Results: Macular hole was developed in 2 of the 7 eyes (28.6%) in the TP group and none in the FN group. Long-term central fovea thickness thinning and decrease of vision were found in the TP group, but not in the FN group (P < 0.05). Inner segment/outer segment line recovered in 75% of the 12 eyes in the FN group, but in only 14.3% of the 7 eyes in the TP group. Conclusion: Preservation of the foveolar cone by foveola nonpeeling surgery correlates with better anatomical and visual results than total peel, prevents long-term foveolar retinal thinning, and successfully saves the fovea from macular hole formation. The concept of foveolar cone structure preservation is best demonstrated by internal limiting membrane surgery of myopic traction maculopathy. While releasing the tangential traction to restore foveal contour, foveola degeneration and macula hole formation were prevented by central 400 μm foveolar ILM preservation after long-term follow-up.