Clinical management of myopia in adults: Treatment of retinal complications

Abstract

Myopic traction maculopathy (MTM) is an important treatable condition among individuals with high myopia. It encompasses a spectrum of conditions ranging from retinal retinoschisis to full-thickness macular hole (FTMH). Traction of various kinds, together with the morphologically changes in eyes with high myopia, play a central role in the pathogenesis. Individuals with MTM in the more advanced stage with visual loss or showing significant progression can be treated surgically, while those with early disease and stable visual acuity should be monitored with optical coherence tomography. Pars plana vitrectomy with peeling of the epiretinal membrane and/or internal limiting membrane (ILM) forms the backbone of the treatment. In the absence of macular hole (MH), various modifications of surgical techniques have been suggested to increase the rate of surgical success and to prevent complications, in particular the formation of secondary macular hole. If macular hole is present, on the other hand, surgical adjuncts have been studied to maximize the rate of macular hole closure. These adjuncts include endotamponade, inverted ILM flap or autologous ILM transplantation, autologous blood/platelet concentrate, lens capsular flap transplantation, macular buckle, and autologous neurosensory retinal transplantation. Advances in surgical instruments and skills have shown promises in the management of this challenging condition.