Fovea-Sparing versus Standard Internal Limiting Membrane Peeling for Myopic Traction Maculopathy: A Study of 102 Consecutive Cases

Purpose: To investigate the long-term outcomes of pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane (ILM) peeling (FSIP) and standard ILM peeling for myopic traction maculopathy (MTM). Design: Retrospective case series. Participants: A total of 102 eyes of 96 consecutive patients who underwent primary PPV for MTM and were followed up for at least 12 months. Methods: We compared the outcomes of eyes that underwent vitrectomy with FSIP from October 2012 to March 2017 with those of eyes that underwent vitrectomy with standard ILM peeling from June 2008 to September 2012. Main outcome measures: Best-corrected visual acuity (BCVA) at 12 months and the final follow-up visit after surgery, time to MTM resolution, and postoperative complications such as macular hole (MH) formation. Results: There were 26 and 76 eyes in the FSIP and standard ILM peeling groups, respectively. In both groups, the mean visual acuity (VA) at the 12-month follow-up was significantly improved relative to the mean preoperative VA (P < 0.001 for both groups). The preoperative and postoperative BCVA (logarithm of the minimum angle of resolution) showed no significant between-group differences (preoperative: 0.60 +/- 0.35 in the FSIP group and 0.61 +/- 0.39 in the standard ILM peeling group, P = 0.935; postoperative BCVA: 0.32 +/- 0.43 in the FSIP group and 0.37 +/- 0.38 in the standard ILM peeling group, P = 0.281). The mean time to the resolution of foveal retinal detachment and schisis was also comparable between groups (8.9 +/- 4.8 months in the FSIP group and 6.9 +/- 4.6 months in the standard ILM peeling group, P = 0.084). None of the eyes in the FSIP group and 6 eyes (8%) in the standard ILM peeling group developed postoperative MH. Consequently, the BCVA at 12 months deteriorated by 3 or more lines for 4 eyes (5%) in the standard ILM peeling group; this deterioration was not observed for any eye in the FSIP group. Risk factors for postoperative MH formation were worse preoperative visual acuity (P = 0.035) and thinner choroidal thickness (P = 0.025). Conclusions: The visual and anatomic improvements after vitrectomy with FSIP may be comparable to those after vitrectomy with standard ILM peeling, with FSIP showing the ability to prevent postoperative MH formation and a consequent impairment in vision. (C) 2020 by the American Academy of Ophthalmology