**5. Treatment**

*A Practical Guide to Clinical Application of OCT in Ophthalmology*

*(a–d) Progression of MTM leading to FRD over a period of 5 years.*

**112**

**Figure 3.**

**Figure 2.**

*detachment in the other eye.*

*(a–c) Progression of MTM in the fellow eye of a patient who had undergone vitrectomy for MTM with foveal* 

The goal of treatment in MTM is to relieve the tractional forces responsible for the formation of MTM [18]. This can be achieved primarily with the help of internal procedure with vitrectomy and external procedure with macular buckle. Pharmacologic vitreolysis can be considered a useful treatment option if vitreomacular traction from the perifoveal PVD or traction associated with a remnant cortical vitreous layer after PVD is responsible for the MTM formation.

The indications of surgery in MTM are:


Most surgeons while dealing with myopic traction maculopathy have two approaches:


Taniuchi et al. [19] evaluated the effect of vitrectomy with and without ILM peeling in 71 eyes of 64 patients with myopic traction maculopathy. They studied the effects on visual acuity and post-operative complications. The results indicated that vitrectomy with ILM peeling can lead to improvement in vision in patients with macular retinoschisis or foveal detachment. Recurrences of tractional macular detachment were also more frequent in eyes without ILM peeling.

## **5.1 Surgical techniques**

Basically, vitrectomy with removal of the posterior cortical vitreous is what is minimally required in relieving the tractional forces responsible for MTM formation. The role of additional procedures like peeling of internal limiting membrane and use of gas tamponade in MTM is debatable. In eyes with MTM secondary to vitreomacular traction from the perifoveal PVD and traction associated with a remnant cortical vitreous layer after PVD, vitrectomy alone with removal of posterior cortical vitreous is sufficient in relieving the traction and achieves a normal retinal anatomy. In eyes with MTM secondary to epiretinal membrane formation, additional removal of epiretinal membrane is required. MTM caused by intrinsic stiffening of the ILM requires peeling of ILM with or without the placement of macular buckle [20, 21]. Few studies have shown that sparing a small island of ILM over the fovea in eyes with MTM can prevent the development of post-operative MHs which are usually difficult to fix [22, 23] (**Table 2**).


#### **Table 2.**

*Surgical decision-making in myopic traction maculopathy based on pathoanatomy seen on optical coherence tomography.*

Common difficulties encountered during vitrectomy in these high myopic eyes are: (1) inability of the smaller gauge instruments to reach the retinal tissue at the macula due to longer axial length; (2) In eyes with posterior staphyloma, the vitreous is strongly adherent to the edge of the staphyloma resulting in retinal breaks during PVD induction; (3) Staining of ILM with various dyes is usually inadequate and patchy making ILM peeling difficult in these scenarios; (4) Glaucoma is associated with high myopia resulting in an already compromised optic nerve head which can get worsened following vitrectomy; (5) Scleral thinning associated with high myopia

#### **Figure 4.**

*(a–b) Pre and post-operative images of a patient with myopic foveoschisis with FRD. At 6 months post-op, there is complete resolution of the retinal thickening and subretinal fluid.*

**115**

provided the original work is properly cited.

Narayana Nethralaya, Bengaluru, India

*OCT Findings in Myopic Traction Maculopathy DOI: http://dx.doi.org/10.5772/intechopen.83766*

**6. Monitoring**

**7. Conclusion**

**Author details**

can lead to catastrophic complications like expulsive hemorrhage. Thus, macular buckle has emerged as a useful and effective treatment option in the management of MTM. However, due to the longer learning curve of this technique and unpredictable outcomes following this procedure, vitrectomy still remains the most preferred treatment modality amongst most vitreoretinal surgeons in the management of MTM.

Following surgery for MTM, resolution of retinal thickening and/or foveal detachment is monitored using OCT. Complete resolution of retinal thickness or subretinal fluid is achieved in 6–9 months after surgery [24] (**Figure 4**). Patients with high myopia and unilateral MTM require regular OCT monitoring of the fel-

One of the important causes for disturbed vision secondary to high myopia is MTM. It may be difficult to appreciate MTM on clinical examination with biomicroscopy. With the advent of OCT, the diagnosis of MTM and a posterior staphyloma can be made easily. Newer generation OCT imaging modalities have helped in the understanding the mechanism of myopic foveoschisis formation and help in deciding the treatment plan by the retinal surgeon. Early detection and referral to a retinal specialist for evaluation and treatment when appropriate may prevent

further vision loss secondary to MH formation and/or retinal detachment.

low eye to assess progression to myopic pre-MTM [25].

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Ramesh Venkatesh\*, Bharathi Bavaharan and Naresh Kumar Yadav

\*Address all correspondence to: vramesh80@yahoo.com

*OCT Findings in Myopic Traction Maculopathy DOI: http://dx.doi.org/10.5772/intechopen.83766*

can lead to catastrophic complications like expulsive hemorrhage. Thus, macular buckle has emerged as a useful and effective treatment option in the management of MTM. However, due to the longer learning curve of this technique and unpredictable outcomes following this procedure, vitrectomy still remains the most preferred treatment modality amongst most vitreoretinal surgeons in the management of MTM.
