The increasing application of optical coherence tomography (OCT) has led to identification of a new cause for visual loss in degenerative myopia—myopic tractional maculopathy (MTM).1, 2, 3 MTM typically manifests as foveal schisis; rarely, it is severe enough to cause a tractional retinal detachment (TRD).4 Most reports describe MTM as an isolated phenomenon.1, 2, 3, 4 We report a rare case of MTM associated with rhegmatogenous retinal detachment (RRD).
Case report
A 38-year-old lady presented to us with defective vision OS for a week. The right eye was blind since childhood. Best-corrected visual acuity (BCVA) was hand motions OD and 3/60 OS. On examination, anterior segment was unremarkable; posterior segment showed myopic chorioretinal degeneration OU. Additionally, OD had extensive pigmentary mottling and subretinal gliosis suggestive of a spontaneously settled RRD. OS showed a fresh subtotal RRD with multiple peripheral breaks; however, macular contours appeared to be concave (Figure 1a). OCT (version3, Carl Zeiss Meditec, Dublin, CA, USA) revealed vitreomacular traction causing focal macular detachment (Figure 1b). She underwent belt-buckling and pars plana vitrectomy; posterior hyaloid was detached and epimacular membranes were removed. Silicone oil was used for tamponade due to the patient's inability to maintain prone position. One month postoperatively, retina was attached OS. OCT confirmed the relief of vitreomacular traction with a shallow lamellar hole. Silicone oil was removed 2 months later. The patient was last reviewed 6 months thereafter: status quo was maintained (Figure 1c and d); final BCVA was 6/18.
Comment
Myopic foveoschisis is characterized by an intraretinal splitting in a myopic posterior staphyloma, caused by anteroposterior and/or tangential traction, sometimes combined with foveal detachment, culminating in a lamellar or full-thickness macular hole.1, 2, 3 Our case was unusual, because the macular TRD was surrounded by convex RRD on all sides, indicating the two pathologies as discrete but synchronous phenomena. It is probable that an acute posterior vitreous detachment simultaneously opened the peripheral retinal tears, as well as pulled at the tenacious vitreomacular adhesions into a TRD. It has been suggested that when the area of adhesion is small (⩽500 μ), a macular hole results; a broader adhesion (∼1500 μ) causes a retinal schisis/detachment.5 Removal of posterior vitreous cortex and epimacular membranes relieved the traction, while possibly deroofing an inner macular schisis into a lamellar hole. It is advisable to include OCT in the preoperative evaluation of a myopic RRD associated with macular staphyloma to reveal such undetected pathologies, which have implications for surgical management.
References
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Shukla, D., Muraly, P. Myopic tractional maculopathy associated with rhegmatogenous retinal detachment. Eye 23, 739–740 (2009). https://doi.org/10.1038/eye.2008.118
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DOI: https://doi.org/10.1038/eye.2008.118