Korean J Ophthalmol.  2020 Feb;34(1):67-75. 10.3341/kjo.2019.0115.

Prognostic Factors Related with Surgical Outcome of Vitrectomy in Myopic Traction Maculopathy

• Kim CY
• Kim MS
• Kim KL
• Woo SJ
• Park KH

• KMID: 2469288
• DOI: http://doi.org/10.3341/kjo.2019.0115

Abstract

PURPOSE
To investigate prognostic factors related to the surgical outcome of vitrectomy in myopic traction maculopathy (MTM).
METHODS
Medical records of patients with MTM who underwent pars plana vitrectomy with internal limiting membrane peeling and follow-up over 12 months were reviewed retrospectively. Best-corrected visual acuity (BCVA), fundoscopic examination and spectral-domain optical coherence tomography findings were evaluated postoperatively. Functional success was defined as visual acuity gain and anatomical success was defined as reduction or resolution of foveoschisis without complications.
RESULTS
This study included 40 eyes of 36 patients. BCVA improved from 0.70 ± 0.44 to 0.63 ± 0.57 logarithm of minimum angle of resolution and central macular thickness decreased from 526.6 ± 132.1 to 277.8 ± 92.1 µm at final follow-up. Functional success was achieved in 24 (60.0%) eyes, and 33 (82.5%) eyes reached anatomical success. Presence of foveal detachment (FD) and higher category of myopic maculopathy were associated with both functional (p = 0.014, 0.021, respectively) and anatomical (p = 0.011, 0.022, respectively) failure. Longer preoperative axial length showed an association with functional failure but not with anatomical failure (p = 0.041). In multivariate analysis, FD was the only prognostic factor for both functional and anatomical outcome (p = 0.041, 0.043, respectively). Preoperative BCVA (r² = 0.259, p = 0.001), axial length (r² = 0.172, p = 0.008), and myopic maculopathy category (r² = 0.336, p < 0.001) showed significant correlation with final BCVA.
CONCLUSIONS
More severe myopic maculopathy and the presence of FD are associated with poorer functional and anatomical outcomes of pars plana vitrectomy in MTM. Better preoperative BCVA, shorter axial length, and less severe myopic maculopathy are correlated with better final BCVA.

Keyword

Myopic foveoschisis; Myopic traction maculopathy; Optical coherence tomography; Vitrectomy

MeSH Terms

Follow-Up Studies
Humans
Medical Records
Membranes
Multivariate Analysis
Retrospective Studies
Tomography, Optical Coherence
Traction*
Visual Acuity
Vitrectomy*

Figure

• 

  Fig. 1 A case of myopic traction maculopathy with foveal detachment after pars plana vitrectomy. (A) Preoperative and (B) final fundus images are presented. Serial optical coherence tomography images are arranged in chronological sequence: (C) preoperative, (D) 1 month, (E) 4 months, (F) 8 months, (G) 14 months, and (H) final. Visual acuities at each postoperative follow-up are indicated at the bottom right of the optical coherence tomography image.

• 

  Fig. 2 A case of myopic traction maculopathy after pars plana vitrectomy with gas tamponade. (A) Preoperative and (B) final fundus images are presented. Serial optical coherence tomography images are arranged in chronological sequence: (C) preoperative, (D) 1 month, (E) 4 months, (F) 8 months, (G) 14 months, and (H) final. Visual acuities at each postoperative follow-up are indicated at the bottom right side of the optical coherence tomography image.

• 

  Fig. 3 A case of myopic traction maculopathy after pars plana vitrectomy without gas tamponade. (A) Preoperative and (B) final fundus images are presented. Serial optical coherence tomography images are arranged in chronological sequence: (C) preoperative, (D) 1 month, (E) 4 months, (F) 8 months, (G) 14 months, and (H) final. Visual acuities at each postoperative follow-up are indicated at the bottom right side of the optical coherence tomography image.

• 

  Fig. 4 A case of myopic traction maculopathy after pars plana vitrectomy with postoperative macular hole (*) development. (A) Preoperative and (B) final fundus images are presented. Serial optical coherence tomography images are arranged in chronological sequence: (C) preoperative, (D) 1 month, (E) 4 months, (F) 8 months, (G) 14 months, and (H) final. Visual acuities at each postoperative follow-up are indicated at the bottom right side of the optical coherence tomography image.

• 

  Fig. 5 Changes of (A) best-corrected visual acuity (BCVA) logarithm of minimum angle of resolution (logMAR) and (B) central macular thickness (CMT) at preoperative and different postoperative follow-up periods. *0.01 < p ≤ 0.05, **p ≤ 0.001.

• 

  Fig. 6 Association between (A) preoperative best-corrected visual acuity (BCVA) logarithm of minimum angle of resolution (logMAR), (B) axial length (mm), (C) myopic maculopathy category and final BCVA (logMAR).

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