ILM peeling techniques in myopic traction maculopathy
Reviewed by Kurt Spiteri Cornish

Myopic traction maculopathy (MTM) is a sight-threatening complication of high myopia including macular retinoschisis (MRS) or foveoschisis, foveal detachment (FD) and myopic macular hole (MMH). Standard surgical treatment is vitrectomy with internal limiting membrane (ILM) peeling, but full-thickness macular hole (FTMH) remains a common complication in about a quarter of patients (28%). Modified surgical techniques have been advocated to avoid this complication. The authors retrospectively compared surgery in 101 eyes of 98 patients with MRS or FD between 2017 and 2020. Patients underwent standard ILM peeling (n=32), fovea-sparing ILM peeling (FSIP n=35) or inverted ILM flap (ILMF, n=34) technique. There was no significant difference in postoperative mean visual acuity with a comparable visual improvement. None of the eyes in the ILMF groups developed postoperative FTMH, whereas 17.1% of the fovea-sparing versus standard internal limiting membrane peeling (FSIP) and 15.6% in the standard ILM peeling group developed FTMH. After adjusting for sex, age and side, the ILM peeling technique was an independent influencing factor for FTMH formation (OR=0.209, p=0.014). There was no significant association between FTMH formation and axial length, MTM type, myopic atrophy maculopathy (MAM), preoperative VA or central foveal thickness. There are significant limitations in this study, including the small number of patients, single surgeon and retrospective design.

Comparison of three internal limiting membrane peeling techniques for myopic traction maculopathy with high risk of postoperative macular hole development.
Feng J, Shao Q, Xie J, et al.
RETINA
2023;43(11):1872–80.